腹腔镜联合胆道镜经胆囊管胆道探查取石术与胆总管切开取石术治疗胆囊结石合并胆管结石患者疗效研究

Comparison of laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration in dealing with patients with gallbladder stones and extrahepatic bile duct stones

目的比较研究腹腔镜联合胆道镜经胆囊管胆道探查取石术(LTCBDE)与腹腔镜胆总管切开取石术(LCBDE)治疗胆囊结石(GS)合并肝外胆管结石(EBDS)患者的疗效。方法2022年1月~2024年1月我院收治的GS合并EBDS患者168例,其中对照组123例接受LCBDE)手术,观察组45例接受LTCBDE手术治疗。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)、白介素(IL)-6和C反应蛋白(CRP),常规检测血生化指标。结果观察组手术时间、术中出血量、肛门排气时间、术后住院日和医疗花费分别为(104.4±34.2)min、(29.9±11.2)ml、(22.3±10.1)h、(6.5±2.9)d和(1.4±0.6)万元,均显著短于或少于对照组【分别为(149.9±37.4)min、(43.6±16.3)ml、(28.4±9.6)h、(9.2±2.4)d和(1.8±0.7)万元,P<0.05】,两组结石清除率均为100.0%;在术后3d,观察组血清肿瘤坏死因子-α和白介素-6水平分别为(32.5±5.9)ng/L和(25.4±7.1)pg/L,均显著低于对照组【分别为(40.3±6.8)ng/L和(35.6±6.4)pg/L,P<0.05】;术后观察组胆漏、胆道感染、腹腔感染、胆道出血和急性胰腺炎发生率分别为0.0%、2.2%、2.2%、0.0%和0.0%,与对照组的2.4%、0.0%、4.1%、1.6%和2.4%比,差异均无统计学意义(P>0.05)。结论LCBDE与LTCBDE手术治疗GS合并EBDS患者均具有较好的清除结石效果,但在术后恢复和花费成本方面,LTCBDE手术更显优异。

Objective The aim of this study was to compare efficacy of laparoscopic transcystic common bile duct exploration(LTCBDE)andlaparoscopic common bile duct exploration(LCBDE)in dealing with patients with gallbladder stones(GS)and extrahepatic bile duct stones(EBDS).Methods A total of 168 patients with GS and EBDS were enrolled in our hospital between January 2022 and January 2024,and we assigned them to LCBDE in 123 cases in control groupand to LTCBDE in 45 cases in observation group.Serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and C-reactive protein(CRP)levels were detected by ELISA,and blood biochemical parameters were routinely assayed.Results Operation time,intra-operational bleeding,anal exhaust time,post-operationalhospital stay and medical cost in the observation group were(104.4±34.2)min,(29.9±11.2)ml,(22.3±10.1)h,(6.5±2.9)d and(14000±600)yuan,all significantly shorter or less tan[(149.9±37.4)min,(43.6±16.3)ml,(28.4±9.6)h,(9.2±2.4)d and(18000±700)yuan,respectively,P<0.05]in the control;total stone clearance was obtained in the two groups;three days after operation,serum TNF-αand IL-6 levels in the observation group were(32.5±5.9)ng/L and(25.4±7.1)pg/L,both significantly lower than[(40.3±6.8)ng/L and(35.6±6.4)pg/L,respectively,P<0.05]in the control;post-operationally,incidences of biliary leakage,biliary tract infection,abdominalinfection,biliary tract hemorrhage and acute pancreatitis in the observation were 0.0%,2.2%,2.2%,0.0%and 0.0%,all not significantly different compared to 2.4%,0.0%,4.1%,1.6%and 2.4%in the control group(P>0.05).Conclusion Both LCBDE and LTCBDE have good efficacy for stone clearance in patients with GS and EBDS,and we recommend LTCBDE for good postoperative recovery and less economic costs.