三镜联合免T管保留Oddi括约肌功能在胆总管结石治疗中的应用

Application of laparoscopy,choledochoscopy and duodenoscopy with T-tube free in the treatment of choledocholithiasis LIU

目的研究腹腔镜、胆道镜和十二指肠镜三镜联合免T管保留Oddi括约肌功能治疗胆总管结石的临床效果,探讨其临床应用价值。方法回顾性分析2021年9月至2023年9月曲靖市第一人民医院分别采用腹腔镜下胆总管探查取石+鼻胆管引流+胆总管一期缝合术(LCBDE+ENBD+PC组,n=38)和腹腔镜下胆总管探查取石+T管引流术(LCBDE+T管引流组,n=49)治疗的胆总管结石患者的临床资料。比较两组的手术时间、术中出血量、术后并发症、住院时间和治疗费用等指标。结果LCBDE+ENBD+PC组与LCBDE+T管引流组在术中出血量[(46±10)mL vs(50±11)mL,t=-1.750,P=0.084]、一次性结石取净率[94.74%(36/38)vs 93.88%(46/49),χ^(2)=0.029,P=0.864]、腹腔引流管拔除时间[(4.3±1.0)d vs(4.4±1.0)d,t=-0.879,P=0.382]方面差异均无统计学意义。LCBDE+ENBD+PC组住院时间[(9±1)d vs(12±2)d,t=-8.456,P<0.001]、总治疗费用[(21750±966)元vs(22862±2026)元,t=-3.177,P=0.002]及并发症发生率[10.53%(4/38)vs 36.73%(18/49),χ^(2)=7.781,P=0.005]均低于LCBDE+T管引流术组。结论LCBDE+ENBD+PC治疗胆总管结石治不仅降低了术后并发症发生率,还能缩短住院时间、减少总治疗费用,避免患者长期带T管的痛苦;该方法同时保护了Oddi括约肌功能,为胆总管结石的治疗提供了新的选择。

Objective To study the clinical effect of laparoscopy,choledochoscopy and duodenoscopy with T-tube free in the treatment of choledocholithiasis.Methods A retrospective analysis was conducted on the clinical data of choledocholithiasis patients,who underwent laparoscopic common bile duct exploration+endoscopic nasobiliary drainage+primary closure(LCBDE+ENBD+PC group,n=38)or laparoscopic common bile duct exploration+endoscopic T-tube drainage(LCBDE+T-tube group,n=49),in the First People’s Hospital of Qujing between Sep.2021 and Sep.2023.The indexes of operation time,intraoperative bleeding,postoperative complications,hospitalization time and cost were compared between the two groups.Results Between the LCBDE+ENBD+PC group and LCBDE+T-tube group,there was no statistical difference in intraoperative bleeding[(46±10)mL vs(50±11)mL,t=-1.750,P=0.084],rate of one-time stone removal[94.74%(36/38)vs 93.88%(46/49),χ^(2)=0.029,P=0.864],or time of abdominal drainage tube remove[(4.3±1.0)d vs(4.4±1.0)d,t=-0.879,P=0.382].The hospitalization time[(9.4±0.9)d vs(11.5±2.1)d,t=-8.456,P<0.001],total cost[(21750±966)yuan vs(22862±2026)yuan,t=-3.177,P=0.002]and complication incidence rate in LCBDE+ENBD+PC group were significantly lower than those in the LCBDE+T-tube group[10.53%(4/38)vs 36.73%(18/49),χ^(2)=7.781,P=0.005].Conclusion LCBDE+ENBD+PC treatment for choledocholithiasis can not only reduce the postoperative complication incidence rate,but also can shorten hospitalization time and total cost,avoid the pain with T-tube for a long time;LCBDE+ENBD+PC treatment can protect Oddi sphincter function,which provide a new way for the treatment of choledocholithiasis.