双镜联合钬激光碎石治疗胆囊及胆总管合并结石的疗效及安全性

Study of the efficacy and safety of double lens combined with holmium laser lithotripsy in the treatment of gallbladder and common bile duct combined with calculi

目的分析双镜联合钬激光碎石治疗胆囊、胆总管合并结石的疗效及安全性。方法选取2016年6月至2019年6月瑞昌市人民医院收治的60例胆囊、胆总管合并结石患者作为研究对象,随机分为常规组与双镜联合组,每组30例。常规组采用开腹胆囊切除术+胆总管切开取石术治疗,双镜联合组采用腹腔镜胆囊切除+经胆道镜胆总管钬激光碎石术治疗。比较两组清除结石率、结石复发率、手术指标、康复指标、手术前后血清应激反应指标[肾上腺素(E)、皮质醇(Cor)]、并发症发生情况。结果两组清除结石率和结石复发率比较差异无统计学意义。双镜联合组手术时间长于常规组,术中出血量少于常规组,肛门排气时间、下床时间、住院时间均短于常规组,差异有统计学意义(P<0.05)。术后,双镜联合组血清E、Cor水平均低于常规组,差异有统计学意义(P<0.05)。双镜联合组术后并发症发生率低于常规组,差异有统计学意义(P<0.05)。结论双镜联合钬激光碎石治疗胆囊、胆总管合并结石能取得与传统开腹术相当的疗效,且创伤应激刺激小,术后康复进程快,并发症少,值得临床推广应用。

Objective To analyze the efficacy and safety of double lens combined with holmium laser lithotripsy in the treatment of gallbladder and common bile duct stones with calculi.Methods 60 patients with gallbladder and common bile duct combined stones with calculi admitted to the People's Hospital of Ruichang from June 2016 to June 2019 were selected as the research subjects,and they were randomly divided into the conventional group and the double-mirror combined group,with 30 cases in each group.The conventional group was treated with open cholecystectomy+choledocholithotomy,and the double-mirror combined group was treated with laparoscopic cholecystectomy+choledochoscopic holmium laser lithotripsy.The stone removal rate,stone recurrence rate,surgical indexes,rehabilitation indexes,serum stress response indexes(epinephrine[E],cortisol[Cor])before and after surgery,and the incidence of complications were compared between the two groups.Results There was no significant difference in stone clearance rate and stone recurrence rate between the two groups.The operation time in the double-mirror combined group was longer than that in the conventional group,the intraoperative blood loss was less than that in the conventional group,and the anal exhaust time,ambulation time and hospitalization time were shorter than those in the conventional group,the differences were statistically significant(P<0.05).After operation,the levels of serum E and Cor in the double-mirror combined group were lower than those in the conventional group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the double-mirror combined group was lower than that in the conventional group,and the difference was statistically significant(P<0.05).Conclusion Double endoscopy combined with holmium laser lithotripsy in the treatment of cholecystolithiasis and choledocholithiasis can achieve the same curative effect as traditional laparotomy,with less traumatic stress,faster postoperative recovery process and fewer complications,and is worthy of clinical promotion and application.