腹腔镜胆总管探查术联合胆囊切除术治疗胆囊及胆总管结石的效果

Effect of laparoscopic common bile duct exploration combined with cholecystectomy on gallbladder and common bile duct stones

目的 探讨腹腔镜下胆总管探查术(LCBDE)联合胆囊切除术(LC)治疗胆囊及胆总管结石的效果及安全性。方法 选取2018年5月至2022年5月于郑州市第二人民医院行手术治疗的97例胆囊及胆总管结石患者为研究对象。按照手术方法的不同分为研究组(n=68)和对照组(n=29)。研究组给予LCBDE联合LC治疗,对照组给予内镜下十二指肠括约肌切开取石术(EST)联合LC治疗。比较两组手术相关指标、住院相关指标,血清促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)和皮质醇(Cor)水平,术后并发症、结石残留率、结石复发率等指标。结果 与对照组比较,研究组术中出血量更少,手术时间更短,手术切口更小,差异均有统计学意义(P<0.05)。与对照组比较,研究组患者VAS评分更低,住院时间更短,住院费用更低,差异均有统计学意义(P<0.05)。两组术后1 d,血清ACTH、NE、Cor水平均升高,但研究组低于对照组,差异均有统计学意义(P<0.05)。两组术后并发症总发生率、结石残留率、结石复发率比较,差异均未见统计学意义(P>0.05)。结论 腹腔镜胆总管探查术联合胆囊切除术是治疗胆囊及胆总管结石有效且安全的方法,单次手术完成,能够减少手术创伤、缩短住院时间、降低住院费用,且不增加术后并发症的发生率。

Objective To investigate the efficacy and safety of laparoscopic common bile duct exploration(LCBDE) combined with cholecystectomy(LC) in the treatment of gallbladder and common bile duct stones. Methods Ninety-seven patients with gallbladder and common bile duct stones who underwent surgical treatment at Zhengzhou Second People's Hospital from May 2018 to May 2022 were selected as the research subjects. They were divided into study group(n=68) and control group(n=29) according to different surgical methods. The study group received LCBDE combined with LC treatment, and the control group received endoscopic duodenal sphincterotomy(EST) combined with LC treatment. The surgical and hospitalization related indicators, serum levels of adrenocorticotropic hormone(ACTH), norepinephrine(NE), and cortisol(Cor), postoperative complications, stone residue rate, stone recurrence rate, and other indicators were compared between the two groups. Results Compared with the control group, the study group had less intraoperative bleeding, shorter surgical time, and smaller surgical incisions, with significant differences(P<0.05).Compared with the control group, the study group had lower VAS scores, shorter hospital stays, and lower hospitalization costs, with significant differences(P<0.05).On the first day after surgery, the serum levels of ACTH, NE, and Cor increased in both groups, but those of the study group was lower than those of the control group, with significant differences(P<0.05). There was no significant difference in the total incidence of postoperative complications, stone residue rate, and stone recurrence rate between the two groups(P>0.05). Conclusions Laparoscopic common bile duct exploration combined with cholecystectomy is an effective and safe method for the treatment of gallbladder and common bile duct stones. It can be completed in a single operation, which can reduce surgical trauma, shorten the length of hospital stay, reduce hospitalization expenses, without increasing the incidence of postoperative complications.