三种微创方式治疗胆总管结石的临床研究

The clinical efficacy of three minimally invasive methods in the treatment of choledocholithiasis

目的技探讨三种微创方式治疗胆总管结石的临床疗效。方法回顾性分析2021年12月-2023年11月太和县人民医院医院肝胆胰外科收治的109例胆总管结石患者的临床资料,按照治疗方式进行分组:LCBDE+胆总管一期缝合组(32例)、LCBDE+胆总管T管外引流组(40例)和ERCP组(37例),观察三组患者平均住院天数、平均住院费用、手术时间、术中出血量、中转开腹率、术后并发症等情况。结果三组患者均顺利完成手术后出院,均未出现中转开腹情况,均未出现严重并发症及死亡。手术出血量:T管外引流组(39.58±7.84)ml,小于一期缝合组(29.13±6.61)ml,两者均小于ERCP组(10.68±2.79)ml,差异具有统计学意义(P<0.05);手术时间:T管外引流组(94.55±35.37)min,一期缝合组(74.53±22.62)min,ERCP组(43.95±13.94)min,三组平均手术时间差异具有统计学意义(P<0.05);T管外引流组患者的的平均AST、TB、DB、HB、GGT下降幅度均大于一期缝合组及ERCP组,差异具有统计学意义(P<0.05);一期缝合组患者平均住院日为(10.56±1.32)d,长于T管外引流组患者平均住院日(12.00±2.29)d,两组患者平均住院日均长于ERCP组(8.00±3.24)d,三组患者间两两比较均存在统计学差异(P<0.05)。平均住院费用:ERCP组患者平均住院费用为(24761.35±3124.32)元,大于一期缝合组患者(18518.03±4259.83)元和T管外引流组患者(18527.54±4431.51)元,且差异均有统计学意义(P<0.05)。而一期缝合组和T管外引流组平均住院费用则无明显统计学差异(P>0.05)。结论胆总管结石治疗行胆总管探查T管外引流依然最安全且稳妥的治疗方式,但临床上究竟采用何种治疗措施,需结合各种客观条件及患者的个人意愿制定个体化的治疗计划。

Objective To explore the clinical efficacy of three minimally invasive methods in the treatment of choledocholithi-asis.Methods The clinical data of 109 patients with choledocholithiasis admitted to the Department of Hepatobiliary and pancreatic Surgery of Taihe County People's Hospital from December 2021 to November 2023 were retrospectively analyzed,and grouped accord-ing to treatment methods:LCBDE+primary choledochal suture group(32 cases),LCBDE+external choledochal T drainage group(40 cases)and ERCP group(37 cases)were observed.The average length of hospital stay,average hospitalization cost,operation time,intraoperative blood loss,conversion rate of laparotomy,postoperative complications,and serological indexes,and success rate of stone removal of the three groups were observed.ResultsAll the patients in the three groups were discharged after successful surgery,and none of them had any serious complications and deaths.The amount of blood loss in the external drainage group(39.58±7.84)ml was smaller than that in the primary suture group(29.13±6.61)ml,and both were smaller than that in the ERCP group(10.68±2.79)ml,the difference was statistically significant(P<0.05).The operation time was(94.55±35.37)min in the external T-tube drainage group,(74.53±22.62)min in the primary suture group,and(43.95±13.94)min in the ERCP group.The mean opera-tion time of the three groups had statistical significance(P<0.05).The average length of hospital stay in the primary suture group was(10.56±1.32)d,which was longer than that in the external T-tube drainage group(12.00±2.29)d,and the average length of hos-pital stay in the two groups was longer than that in the ERCP group(8.00±3.24)d,and there were statistical differences in mean length of hospital stay between the three groups(P<0.05).Average hospitalization cost:The average hospitalization cost of patients in ERCP group was(24761.35±3124.32)yuan,which was higher than that of patients in primary suture group(18518.03±4259.83)yuan and patients in external T-tube drainage group(18527.54±4431.51)yuan,and the differences were statistically significant(P<0.05).There was no significant difference in average hospitalization cost between the primary suture group and the T-tube drainage group(P>0.05).Conclusion Choledocholithiasis treatment with choledochal exploration and T tube drainage is still the safest and safest way to treat choledocholithiasis,but the clinical treatment measures should be combined with various objective conditions and patients'personal wishes to develop an individualized treatment plan.