三镜联合手术治疗胆囊结石合并肝外胆管结石的临床研究

Clinical Study of Three-mirror Combined Surgery in the Treatment of Gallstones with Extrahepatic Bile Duct Stones

目的探讨三镜联合手术治疗胆囊结石合并肝外胆管结石的临床价值。方法将2018年1月至2020年12月我院收治的100例胆囊结石合并肝外胆管结石患者按抽签法分为对照组和观察组各50例。对照组接受开腹胆囊切除术(Open cholecystectomy,OC)、胆总管探查取石术(Lapamscopic common bile duct exploration,LCBDE)联合T管引流术(T tube drainage,TD)治疗,观察组接受内镜下逆行胰胆管造影术(Endoscopic retrograde cholangio-pancreatography,ERCP)、十二指肠镜下乳头括约肌切开术(Endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)治疗。对两组手术情况、术后情况、并发症发生情况及术后不同时间点疼痛程度展开统计学分析。结果观察组手术时间、住院时间较对照组更短,术中出血量较对照组更少,住院费用较对照组更低,差异有统计学意义(P<0.05)。观察组术后首次排气时间、首次进食时间及腹腔引流时间短于对照组,差异有统计学意义(P<0.05)。观察组术后1~3 d的视觉模拟评分法(Visualanaloguescale,VAS)评分较对照组更低,差异有统计学意义(P<0.05)。观察组术后并发症总发生率为6.00%,低于对照组的20.00%,差异有统计学意义(P<0.05)。结论对胆囊结石合并肝外胆管结石患者行ERCP+EST+LC治疗有快捷、创伤小、术后疼痛轻、并发症少及恢复快等优点,值得推广。

Objectives To investigate the clinical value of three-mirror combined surgery in the treatment of gallstones with extrahepatic bile duct stones.Methods A total of 100 patients with gallstones and extrahepatic bile duct stones admitted to our hospital from January 2018 to December 2020 were selected and divided into control group and observation group according to the lottery method,with 50 cases in each group.The control group was treated with open cholecystectomy(OC),lapamscopic common bile duct exploration(LCBDE)combined with T tube drainage(TD).The observation group was treated with endoscopic retrograde cholangio-pancreatography(ERCP),endoscopic sphincterotomy(EST)combined with laparoscopic cholecystectomy(LC).The operation conditions,postoperative conditions,complications and pain degree at different time points after operation were statistically analyzed in the two groups.Results The operation time and hospitalization time of the observation group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the hospitalization cost was lower than that of the control group,the differences were statistically significant(P<0.05).The first exhaust time,first feeding time and abdominal drainage time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The visual analogue scale(VAS)score of the observation group was significantly lower than that of the control group at 1-3 days after operation(P<0.05).The total incidence of postoperative complications in the observation group was 6.00%,which was significantly lower than the 20.00%in the control group(P<0.05).Conclusions ERCP+EST+LC treatment for patients with gallstones and extrahepatic bile duct stones has the advantages of fast,less trauma,less postoperative pain,fewer complications and faster recovery,which is worthy of promotion.