腹腔镜、十二指肠镜联合胆道镜治疗肝外胆管结石的疗效分析

Efficacy of laparoscopy and duodenoscopy combined with choledochoscopy in the treatment of biliary calculi

目的观察腹腔镜、十二指肠镜联合胆道镜治疗肝外胆管结石的疗效,旨在为该病治疗方案的制定提供数据支持。方法选择鄞州人民医院肝胆外科2017年8月—2018年8月明确诊断为肝外胆管结石的82例患者,按照随机数表法将其纳入对照组(41例)和观察组(41例),对照组行常规腹腔镜联合胆道镜手术治疗,观察组行腹腔镜、十二指肠镜联合胆道镜治疗,对比2组的手术成功率、结石取净率、临床疗效、临床指标(手术时间、出血量、肛门排气时间、胃肠功能恢复时间、下床活动时间、住院时间)、并发症(切口感染、胆总管损伤、胆漏、消化道穿孔)以及生活质量(SF-36评分)。结果观察组手术成功率(97.6%)高于对照组(80.5%);观察组总有效率(92.7%)高于对照组(75.6%);观察组的手术时间长于对照组,出血量、肛门排气时间、胃肠功能恢复时间、下床活动时间、住院时间均少于对照组;观察组并发症发生率(4.9%)低于对照组(19.5%);观察组SF-36各项目得分均高于对照组;各项差异均有统计学意义(均P<0.05)。观察组结石取净率(95.1%)略高于对照组(90.2%),差异无统计学意义(P>0.05)。结论三镜联合治疗肝外胆管结石的疗效显著,具有成功率高、康复快、预后佳等优势,值得推行。

Objective To observe the efficacy and safety of laparoscopy, duodenoscopy and choledochoscope in the treatment of extrahepatic bile duct stones, in order to provide data support for the formulation of treatment plan. Methods Total 82 patients with extrahepatic bile duct stones diagnosed in our department from August 2017 to August 2018 were selected. They were included in the control group(41 cases) and the observation group(41 cases) according to the random number table method. The control group was treated with routine laparoscopic combined with choledochoscope. The observation group was treated with laparoscopic and duodenoscope combined with choledochoscope. The success rate, stone removal rate and prognosis of the two groups were compared. Bed efficacy, clinical indicators(operation time, bleeding volume, anal exhaust time, recovery time of gastrointestinal function, out-of-bed activity time, hospital stay), complications(incision infection, common bile duct injury, bile leakage, gastrointestinal perforation) and quality of life(SF-36 score). Results The success rate(97.6%) of the observation group was higher than that in the control group(80.5%), the total efficiency of the Observation Group(92.7%) was higher than that in the control group(75.6%), and the operation time of the observation group was longer than that in the control group. The incidence of complications in the Observation Group(4.9%) was lower than that in the control group(19.5%), the scores of SF-36 in the observation group were higher than those in the control group, and the differences were statistically significant in each group(all P<0.05). The stone clearance rate in the observation group(95.1%) was slightly higher than that in the control group(90.2%), with no significant difference(P>0.05). Conclusion The three-mirror combination therapy for extrahepatic bile duct stones is effective, with high success rate, rapid recovery, good prognosis and other advantages, which is worth promoting.