腹腔镜与十二指肠镜联合应用于胆囊结石合并胆管结石的疗效及结石残留和并发症的分析

Efficacy of laparoscopy combined with duodenoscopy in the treatment of gallbladder stones combined with extrahepatic bile duct stones and analysis on the residual stones and complications

目的:探究腹腔镜与十二指肠镜联合治疗胆囊结石合并胆管结石效果及对结石残留和并发症的影响。方法:回顾性分析2019年6月—2020年6月接受治疗的89例胆囊结石合并胆管结石患者的临床资料,根据患者使用手术类型进行分组,观察组患者实施腹腔镜与十二指肠镜联合治疗(n=46);对照组患者实施传统开腹手术治疗(n=43)。比较两组患者手术情况(手术时间、术中出血量、住院时间、住院费用)、术后恢复情况(肠功能恢复时间、腹腔引流时间、术后镇痛情况)、术后并发症情况差异,比较两组患者手术半年后疗效差异。结果:观察组患者手术时间、术中出血量、住院时间、肠功能恢复时间、腹腔引流时间、术后镇痛率均低于对照组,观察组患者住院费用高于对照组(均P<0.05);两组患者急性胰腺炎、手术切口感染、胆道出血、胆管结石残留发生率无显著性差异(均P>0.05),观察组患者胆瘘发生率低于对照组(P<0.05);手术半年后,两组患者反流性胆管炎、胆道狭窄、结石复发率无显著性差异(均P>0.05)。结论:腹腔镜与十二指肠镜联合治疗胆囊合并胆管结石效果较好,且有利于患者术后恢复,术后并发症少。

Objective:To explore the effects of laparoscopy combined with duodenoscopy in the treatment of gallbladder stones with extrahepatic bile duct stones and its influence on residual stones and complications.Methods:The clinical data of 89 patients with gallbladder stones complicated with extrahepatic bile duct stones who were treated from June 2019 to June 2020 were retrospectively analyzed.The patients were grouped according to the surgical types,patients in the observation group received laparoscopy combined with duodenoscopy(n=46),and patients in the control group underwent traditional open surgery(n=43).The difference in surgical condition(surgical time,intraoperative blood loss,hospital stay,and hospitalization expense),postoperative recovery(intestinal function recovery time,abdominal drainage time,and postoperative analgesia),and postoperative complications were com‑pared between the two groups of patients.The difference in curative effect after 6 months of surgery was compared between the two groups of patients.Results:The surgical time,intraoperative blood loss,hospital stay,intestinal function recovery time,abdominal drainage time,and postoperative analgesia rate of the observation group were less or lower than that of the control group,and the hospitalization expense of the observation group was higher than that of the control group(all P<0.05).There was no significant difference in the incidence rates of acute pancreatitis,surgical incision infection,hemobilia,and residual bile duct stones between the two groups(all P>0.05),and the incidence rate of biliary fistula of the observation group was lower than that of the control group(P<0.05).At the end of 6 months after surgery,there was no significant difference in the regurgitation cholangitis,biliary stricture,and stone recurrence rates between the two groups(all P>0.05).Conclusion:Laparoscopy combined with duodenoscopy is effective in the treatment of gallbladder stones with extrahepatic bile duct stones,and it is beneficial to the postoperative recovery of patients,with fewer postoperative com‑plications.