腹腔镜联合胆道镜治疗胆总管结石的临床疗效分析

Clinical efficacy analysis of laparoscopy combined with choledochoscopy in the treatment of choledocholithiasis

目的:分析腹腔镜联合胆道镜治疗胆总管结石的临床疗效。方法:选取2020年3月至2022年6月收治的64例胆总管结石患者作为研究对象,均合并胆囊结石、急/慢性胆囊炎,按手术方法分为两组,观察组(n=24)行腹腔镜联合胆道镜手术,对照组(n=40)行开腹胆囊切除术联合胆道镜胆总管切开取石术。比较两组临床疗效及术后疼痛情况。结果:观察组手术时间、肛门排气时间、术后住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);两组术前疼痛评分、谷丙转氨酶、C反应蛋白、总胆红素水平差异无统计学意义(P>0.05),术后上述指标均有好转,观察组低于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石效果良好,与开腹手术相比,手术创伤更小,相关肝功及炎症指标改善效果更加显著,不仅能够减轻术后疼痛感,同时还降低了术后并发症发生风险,安全性更佳。

Objective:To analyze the clinical efficacy of laparoscopy combined with choledochoscopy in the treatment of choledocholithiasis.Methods:In this study,64 choledocholithiasis patients who had concurrent gallbladder stones and acute or chronic cholecystitis from Mar.2020 to Jun.2022 were selected as the research subjects.They were divided into two groups according to different surgical methods,the observation group(n=24)underwent laparoscopy and choledochoscopy combined surgery and the control group(n=40)underwent open cholecystectomy and choledocholithotomy combined with choledochoscopy.The clinical efficacy and postoperative pain of the two groups were compared.The therapeutic effects of the two groups were analyzed in terms of perioperative indicators,pain scores,serum indicators and postoperative complications.Results:The operation time,the time of anal exhaust and hospital stay in the observation group were shorter than those in the control group,and the amount of intraoperative bleeding was less than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in pain score,glutamic-pyruvic transa-minase,C reactive protein,total bilirubin levels between the two groups before operation(P>0.05).The above indicators took a turn for the better in the two groups after operation.The above indicators in the observation group were significantly lower than those in the control group,and the differences of each indicator were statistically significant(P<0.05).The observation group had lower incidence of postoperative complications than the control group,and the difference was statistically significant(P<0.05).Conclusions:In the clinical treatment of choledocholithiasis,laparoscopy combined with choledochoscopy has achieved good results.Compared with open surgery for the same disease,the improvement of related liver function and inflammation indicators is more significant,and the surgery is less traumatic.This procedure can not only reduce the postoperative pain,but also reduce the risk of postoperative complications,with better safety.