双镜联合胆管切开取石留置T管与一期缝合治疗胆囊结石合并胆总管结石的效果比较

Comparison of effect of double mirror combined with choledochotomy and indwelling T-tube and one-stage suture in treatment of cholecystolithiasis combined with choledocholithiasis

目的探讨双镜联合胆管切开取石留置T管与一期缝合治疗胆囊结石合并胆总管结石的效果。方法选取2020年4月至2022年3月南阳市中心医院收治的胆囊结石合并胆总管结石患者126例,随机分为缝合组与引流组各63例,两组均行双镜联合胆总管切开取石术,缝合组采用一期缝合,引流组留置T管,比较两组围术期指标、肝功能与电解质水平、炎症指标、并发症与结石残留情况及生活质量。结果缝合组肛门通气时间、术后禁食时间、疼痛药使用率、住院时间、治疗费用分别为(22.14±5.28)h、(2.35±0.56)d、6.35%、(4.38±0.85)d、(2.24±0.67)万元,均低于引流组(P<0.05);两组手术前后肝功能指标与钠离子水平差异无统计学意义(P>0.05);术后缝合组白细胞计数、C反应蛋白、降钙素原水平分别为(6.32±1.16)×10^(9)/L、(6.93±1.58)mg/L、(4.83±1.24)U/L,均低于引流组(P<0.05);缝合组术后胆漏发生率(0.00%)低于引流组(11.11%)(P<0.05),两组其他并发症与结石残留发生率差异无统计学意义(P>0.05);缝合组术后生理机能、生理职能、躯体疼痛、精神健康、总体健康评分为(77.62±8.73)、(79.86±8.67)、(80.86±8.62)、(78.97±6.92)、(79.64±8.26),均高于引流组(P<0.05)。结论与留置T管比较,镜联合胆管切开取石一期缝合治疗胆囊结石合并胆总管结石可加速术后康复,减少胆漏发生率,改善术后炎症反应,提高患者术后生活质量。

Objective To investigate the effect of double mirror combined with choledochotomy and indwelling T-tube and one-stage suture in the treatment of cholecystolithiasis combined with choledochothiasis.Methods Totally 126 patients with cholecystolithiasis combined with choledocholithiasis admitted from April 2020 to March 2022 were randomly divided into suture group and drainage group with 63 patients in each group.Both groups received double-lens combined choledocholithotomy and lithotomy.Perioperative indexes,liver function and electrolyte levels,inflammatory indexes,complications,stone residue and quality of life were compared between the two groups.Results In the suture group,the anal ventilation time,postoperative fasting time,pain drug utilization rate,hospital stay and treatment cost were(22.14±5.28)h,(2.35±0.56)d,6.35%,(4.38±0.85)d,(2.24±0.67)ten thousand yuan,respectively.They were lower than in drainage group(P<0.05).There was no significant difference in liver function index and sodium ion level between the two groups before and after operation(P>0.05).The levels of white blood cell count,C-reactive protein and procalcitonin in the suture group were(6.32±1.16)×10^(9)/L,(6.93±1.58)mg/L and(4.83±1.24)U/L,respectively.They were lower than in drainage group(P<0.05).The incidence of postoperative bile leakage in suture group(0.00%)was lower than that in drainage group(11.11%)(P<0.05),and there was no significant difference in the incidence of other complications and stone residue between the two groups(P>0.05).The scores of physiological function,physiological function,physical pain,mental health and overall health in sutures group were(77.62±8.73),(79.86±8.67),(80.86±8.62),(78.97±6.92),(79.64±8.26).They were higher than those in drainage group(P<0.05).Conclusion Compared with indenting-T-tube,endoscopic combined with choledocholithiasis and one-stage suture for cholecystolithiasis can accelerate postoperative recovery,reduce the incidence of choledocholithiasis,improve postoperative inflammatory response,and improve patients'postoperative quality of life.