腹腔镜联合胆道镜三种术式治疗肝外胆管结石近中期随访及转归分析

Three surgical treatments of Laparoscopic combined withbiliaryoscopy for the treatment of extrahepatic bile duct stones in the near and medium term follow-up and outcome analysis

目的按探讨腹腔镜联合胆道镜三种术式治疗肝外胆管结石近中期随访及转归。方法去收集2018年3月至2022年3月在我院就诊的111例肝外胆管结石患者病例资料,根据术式的不同分为A组(24例,腹腔镜联合胆道镜经胆囊管微切开胆管取石+一期缝合术)、B组(64例,腹腔镜联合胆道镜经胆总管切开胆管取石+一期缝合术)、C组(23例,腹腔镜联合胆道镜经胆总管切开胆管取石+留置T管术)。采用SPSS23.0统计分析软件,正态分布资料统计描述采用(x±s)表示,多组比较假设检验采用单因素方差分析,两两比较采用LSD法进行;不满足正态分布资料统计描述采用[中位数(Q1,Q3)]表示,组间比较采用秩和检验,两两比较采用Bonferroni校正;并发症、结石复发率等计数资料,以率表示,比较采用χ2检验。P<0.05为差异有统计学意义。结果手术时间三组间有统计学差异,进一步比较知B组最短,C组时间最长。术后排气时间,三组间有统计学差异,进一步比较知A组最短,C组最长。关于术后第1天CRP、白介素6,组间比较差异均有统计学意义,进一步比较知A组炎症反应最轻,B组炎症反应最重,但B组与C组炎症反应无统计学差异。术后住院时间、术中出血量、住院费用、腹腔引流时间,组间比较差异无统计学意义。三种手术方式并发症比较无统计学差异。结论对于胆总管扩张肝外胆管结石患者,推荐选择腹腔镜联合胆道镜经胆囊管微切开胆管取石或腹腔镜联合胆道镜经胆总管切开胆管取石+一期缝合术,尤其是腹腔镜联合胆道镜经胆囊管微切开胆管取石。

Objective Three surgical treatments ofLaparoscopic combined withbiliaryoscopy for the treatment of extrahepatic bile duct stones in the near and medium term follow-up and outcome analysis.Methods The case data of 1ll patients with extrahepatic bile duct stones who visited our hospital from March 2018 to March 2022 were collected,and were divided into group A(24 cases,laparoscopic combined with biliaryoscopy transchocystic canal micro-incision bile duct stone retrieval+primary suture),group B(64 cases,laparoscopic combined with biliaryoscopy transbiobiliation bile duct incision bile duct stone retrieval+primary suture),group C(23 cases,laparoscopic combined biliary tract microscopy transbiobiliation bile duct incision bile duct stone removal+indwelling T tube surgery).Using SPSS 23.O statistical analysis software.The statistical description of normal distribution data was expressed as(x±s),the hypothesis test of multiple group comparison was performed by one-way analysis of variance,and the LSD method was used for pairwise comparison.Median(Q1,Q3)was used for statistical description of data that did not meet normal distribution,and rank-sum test was used for comparison between groups.Pairwise comparison using Bonferroni correction.Results There was statistical difference among the three groups in the operation time.Further comparison showed that group B was the shortest,group C was the longest.There was statistical difference in postoperative exhaust time among the three groups.Further comparison showed that group A was the shortest,group C was the longest,As for CRP and interleukin-6 on the first day after operation,the differences between groups were statistically significant.The inflammatory reaction in group A was the lightest and that in group B was the heaviest,but there was no statistical difference between group B and group C.Postoperative hospital stay,intraoperative bleeding volume,hospitalization costs,and abdominal drainage time were not statistically significant in comparison among the three groups.There was no significant difference in the complications of the three surgical methods.Conclusion For patients with choledochal dilatation and extrahepatic bile duct stones,it is recommended to select laparoscopic combined with choledochoscopy for bile duct lithotomy through the gallbladder duct or laparoscopic combined with choledochoscopy for bile duct lithotomy through the common bile duct+one-stage suture,especially laparoscopic combined with choledochoscopy for bile duct lithotomy through the gallbladder duct.