腹腔镜胆总管探查术在胆道复发结石二次手术中的疗效评价

Evaluation of efficacy of laparotomy and laparoscopy combined with choledochoscopy in the two operation of complex circulation of biliary calculi

目的 探讨腹腔镜胆总管探查术(laparotomy and laparoscopy combined with choledochoscopy,LCDE)在胆道结石复发行二次手术治疗中的临床疗效。方法 回顾性收集南阳市中心医院胆道普外科于2019年8月至2022年3月期间收治的68例有一次胆道结石手术史的胆道复发结石行二次手术治疗患者的临床资料,根据接受的手术类型分为LCDE组(n=36)和开腹组(n=32),对两组患者个人资料、临床数据及随访资料进行统计分析,比较LCDE组和开腹组患者的手术疗效。结果 LCDE组和开腹组治愈率和近、远期并发症无明显差异(P>0.05);LCDE组中转开腹率低,且在患者手术时间、术中出血量、术后排气时间、住院时间、住院费用等方面均优于开腹组,差异均有统计学意义(P<0.05)。结论 腹腔镜胆总管探查术二次手术治疗胆道复发结石安全可行有效,且在一定程度上利于患者术后康复、减少医疗费用,对于术前诊断明确的患者可首选LCDE。

Objective To investigate clinical efficacy of laparotomy and laparoscopy combined with choledochoscopy(LCDE) in the two operation of complex circulation of biliary calculi.Methods The clinical data of 68 patients with recurrent bile duct stones who had a history of surgery for one time were retrospectively collected from the Department of General Biliary Surgery of Nanyang Central Hospital from August 2019 to March 2022,and were divided into LCDE group(n=36) and laparotomy group(n=32) according to the type of surgery.The personal data,clinical data and follow-up data of the two groups were statistically analyzed,and the surgical efficacy of patients in LCDE group and laparotomy group was compared.Results Between LCDE group and laparotomy group,the cure rate and short-term and long-term complications had no significant difference(P>0.05);The rate of conversion to laparotomy was low in LCOE group,LCDE group in surgery time,bleeding volume,postoperative exhaust time,hospitalization time,hospitalization expenses were better than the laparotomy group,the differences were statistically significant(P<0.05).Conclusion Laparoscopic common bile duct exploration is a safe,feasible and effective secondary operation for the treatment of recurrent bile duct stones,and to a certain extent,it is beneficial for patients to recover after surgery and reduce medical costs.For patients with definite preoperative diagnosis,LCDE can be the first choice,and to a certain extent,it is conducive to postoperative rehabilitation.