腹腔镜联合胆道镜胆总管切开取石一期缝合的临床效果

Clinical effect of laparoscopy combined with laparoscopic common bile duct exploration and one-stage suture

目的探讨腹腔镜联合胆道镜胆总管切开取石(LCBDE)一期缝合的临床效果。方法回顾性分析2017年3月至2021年3月泗洪医院收治的78例胆总管结石患者的临床资料,根据取石后是否放置T管分为缝合组(n=40)与引流组(n=38),缝合组采用腹腔镜联合LCBDE一期缝合,引流组采用T管引流术,比较两组围手术期相关指标、术后并发症发生情况及炎症指标。结果缝合组术后住院时间、早期活动时间、手术时间、腹腔引流时间均短于引流组,治疗费用少于引流组,差异有统计学意义(P<0.05);两组术中出血量比较差异无统计学意义。两组术后并发症发生率比较差异无统计学意义。术前,两组WBC、C反应蛋白(CRP)、降钙素原(PTC)水平比较差异无统计学意义;术后3d,两组WBC、CRP、PTC水平均高于术前,但缝合组低于引流组,差异有统计学意义(P<0.05)。结论腹腔镜联合LCBDE一期缝合可显著优化手术指标及炎症指标,不增加围手术期风险,安全有效,有利于患者术后恢复,值得临床推广应用。

Objective To investigate the clinical effect of laparoscopy combined with laparoscopic common bile duct exploration(LCBDE)and one-stage suture.Methods The clinical data of 78 patients with choledocholithias admitted to Sihong Hospital from March 2017 to March 2021 were retrospectively analyzed,they were divided into the suture group(n=40)and the drainage group(n=38)according to whether T tube was placed after lithotomy.The suture group was treated with laparoscopic combined with LCBDE was used for one-stage suture,and drainage group was was treated with T-tube drainage,the perioperative indexes,postoperative complications and inflammatory indexes were compared between the two groups.Results The postoperative hospital stay,early activity time,operation time and abdominal drainage time in the suture group were shorter than those in the drainage group,and the treatment cost was less than that in the drainage group,the differences were statistically significant(P<0.05);there was no significant difference in intraoperative blood loss between the two groups.There was no significant difference in the incidence of postoperative complications between the two groups.Before operation,there was no significant difference in WBC,C-reactive protein(CRP)and procalcitonin(PTC)levels between the two groups.3 d after operation,WBC,CRP and PTC levels of the two groups were higher than before opera-tion,and the suture group were lower than drainage group,the differences were statistically significant(P<0.05).Conclusion Laparoscopy com-bined with LCBDE and one-stage suture can significantly optimize surgical indicators and inflammatory indicators,without increasing perioperative risk,and is safe and effective,conducive to postoperative recovery of patients,and worthy of clinical promotion and application.