腹腔镜下胆总管切开取石术一期缝合治疗继发性胆总管结石的临床疗效分析

Clinical efficacy analysis of laparoscopic choledocholithotomy and primary suture in the treatment of secondary common bile duct stones

目的探究腹腔镜下胆总管切开取石术一期缝合治疗继发性胆总管结石的临床疗效。方法100例继发性胆总管结石患者,随机分为对照组以及观察组,每组50例。对照组采用腹腔镜下胆总管切开取石术+T管引流治疗,观察组采用腹腔镜下胆总管切开取石术一期缝合治疗。比较两组患者手术相关指标,并发症发生情况,视觉模拟评分法(VAS)评分,住院时间,生活质量评分。结果观察组患者的手术时间(91.42±18.60)min、胃肠功能恢复时间(29.55±8.02)h均明显短于对照组的(126.33±24.36)min、(45.01±9.11)h,术中出血量(31.02±7.69)ml明显少于对照组的(40.10±8.09)ml,差异具有统计学意义(P<0.05)。治疗后,观察组患者的并发症发生率6.00%明显低于对照组的22.00%,差异具有统计学意义(P<0.05)。术前,两组VAS评分对比差异无统计学意义(P>0.05);术后,观察组VAS评分(2.30±1.03)分明显低于对照组的(3.46±1.30)分,差异具有统计学意义(P<0.05)。观察组患者的住院时间(6.50±1.08)d明显短于对照组的(8.44±2.16)d,差异具有统计学意义(P<0.05)。治疗后,观察组生理职能、心理健康、社会功能评分分别为(89.83±6.05)、(83.80±5.03)、(82.99±4.07)分,均明显高于对照组的(82.61±4.90)、(76.33±3.72)、(76.39±4.16)分,差异具有统计学意义(P<0.05)。结论继发性胆总管结石患者采用腹腔镜下胆总管切开取石术一期缝合进行治疗,能够有效改善患者的手术相关指标,降低并发症发生率,缩短住院时间,提高生活质量并减轻疼痛程度,在实际应用过程中具有显著疗效,值得进一步的推广与应用。

Objective To investigate the clinical efficacy of laparoscopic choledocholithotomy and primary suture in the treatment of secondary common bile duct stones.Methods A total of 100 patients with secondary common bile duct stones were randomly divided into control group and observation group,with 50 cases in each group.The control group was treated with laparoscopic choledocholithotomy and T tube drainage,and the observation group was treated with laparoscopic choledocholithotomy and primary suture.The surgical related indicators,complications,visual analogue scale(VAS)score,length of hospital stay and quality of life score were compared between the two groups.Results The operative time of(91.42±18.60)min and gastrointestinal function recovery time of(29.55±8.02)h in the observation group were significantly shorter than those of(126.33±24.36)min and(45.01±9.11)h in the control group;the intraoperative blood loss of(31.02±7.69)ml in the observation group was significantly less than that of(40.10±8.09)ml in the control group;the differences were statistically significant(P<0.05).After treatment,the complication rate of 6.00%in the observation group was significantly lower than that of 22.00%in the control group,and the difference was statistically significant(P<0.05).Before surgery,there was no statistically significant difference in VAS scores between the two groups(P>0.05).After surgery,VAS score of(2.30±1.03)points in the observation group was significantly lower than that of(3.46±1.30)points in the control group,and the difference was statistically significant(P<0.05).The length of hospital stay of(6.50±1.08)d in the observation group was significantly shorter than that of(8.44±2.16)d in the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of role-physical,mental health and social function in the observation group were(89.83±6.05),(83.80±5.03)and(82.99±4.07)points,which were significantly higher than those of(82.61±4.90),(76.33±3.72)and(76.39±4.16)points in the control group,and the differences were statistically significant(P<0.05).Conclusion In the process of treating patients with secondary common bile duct stones,laparoscopic choledocholithotomy and primary suture can effectively improve the surgical related indicators of patients,lower complication rate,shorten the length of hospital stay,improve the quality of life and relieve pain.It has excellent results in the actual application process,and is worthy of further promotion and application.