经双镜联合胆总管探查术及胆道内支架置入一期缝合术治疗胆囊结石合并胆总管结石的临床效果研究

Clinical Effect of Double Endoscopic Combined with Common Bile Duct Exploration and Primary Suture of Common Bile Duct with Biliary Stent Implantation in the Treatment of Cholecystolithiasis Complicated with Choledocholithiasis

目的研究经双镜联合胆总管探查术及胆道内支架置入一期缝合术治疗对胆囊结石合并胆总管结石患者的临床疗效。方法选取2021年1月-2023年4月在我院诊治的90例胆囊结石合并胆总管结石患者为研究对象,采用随机数字表法分为对照组、研究1组、研究2组,各组30例。对照组采用开腹手术,研究1组采用双镜联合胆总管探查术及T管引流术,研究2组采用双镜联合胆总管探查术及胆道内支架置入一期缝合术。比较3组手术指标(术中出血量、引流管留置时间、手术时间、术后肛门排气时间、住院时间)、肝功能指标[谷氨酰转肽酶(GGT)、总胆红素(TBIL)]、炎性指标[C反应蛋白(CRP)、白细胞(WBC)]及术后并发症发生率。结果研究2组、研究1组术中出血量、引流管留置时间均短对照组(P<0.05),但研究1组与研究2组比较,差异无统计学意义(P>0.05);研究2组、研究1组手术时间、术后肛门排气时间、住院时间均短于对照组,且研究2组均短于研究1组(P<0.05);3组GGT、TBIL均低于术前,且研究2组、研究1组低于对照组,研究2组低于研究1组(P<0.05);3组CRP、WBC均高于术前,且研究2组、研究1组低于对照组,研究2组低于研究1组(P<0.05);研究1组、研究2组并发症发生率均低于对照组,且研究2组低于研究1组(P<0.05)。结论胆囊结石合并胆总管结石采用经双镜联合胆总管探查术及胆道内支架置入一期缝合术治疗效果更优,可减轻术后炎症反应、肝脏损伤,改善肝胆功能,降低并发症发生率,利于患者康复,值得临床推广应用。

Objective To study the clinical efficacy of double endoscopic combined with common bile duct exploration and primary suture of common bile duct with biliary stent implantation in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods A total of 90 patients with cholecystolithiasis and choledocholithiasis who were treated in our hospital from January 2021 to April 2023 were selected as the research objects.They were divided into control group,study 1 group and study 2 group by random number table method,with 30 patients in each group.Control group was treated with laparotomy,study 1 group was treated with double endoscopy combined with common bile duct exploration and T-tube drainage,and study 2 group was treated with double endoscopic combined with common bile duct exploration and primary suture of common bile duct with biliary stent implantation.The operation indexes(intraoperative blood loss,drainage tube indwelling time,operation time,postoperative anal exhaust time,hospitalization time),liver function indexes[glutamyl transpeptidase(GGT),total bilirubin(TBIL)],inflammatory indexes[C-reactive protein(CRP),white blood cell(WBC)]and incidence of postoperative complications were compared among the three groups.Results The intraoperative blood loss and drainage tube indwelling time in study 2 group and study 1 group were shorter than those in control group(P<0.05),however,there were no significant difference between the study group 1 and the study group 2(P>0.05)..The operation time,postoperative anal exhaust time and hospitalization time of study 2 group and study 1 group were shorter than those of control group,and those of study 2 group were shorter than those of study 1 group(P<0.05).GGT and TBIL in the three groups were lower than those before operation,and those in study 2 group and study 1 group were lower than those in control group,and those in study 2 group were lower than those in study 1 group(P<0.05).The levels of CRP and WBC in the three groups were higher than those before operation,and those in study 2 group and study 1 group were lower than those in control group,and those in study 2 group were lower than those in study 1 group(P<0.05).The incidence of complications in study 1 group and study 2 group was lower than that in control group,and that in study 2 group was lower than study 1 group(P<0.05).Conclusion Double endoscopic combined with common bile duct exploration and primary suture of common bile duct with biliary stent implantation are more effective in the treatment of cholecystolithiasis complicated with choledocholithiasis,which can reduce postoperative inflammatory reaction,liver injury,improve hepatobiliary function,reduce the incidence of complications,and is conducive to the rehabilitation of patients.It is worthy of clinical application.