经腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果

Clinical application of laparoscopic joint choledochoscope for treatment of gallbladder and bile duct stones

目的探讨经腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果。方法将2013年1月至2015年1月收治的128例胆囊结石合并胆总管结石的患者,按照随机数字表法分为对照组和观察组,每组64例。对照组给予腹腔镜胆囊切除术联合内镜下乳头括约肌切开术治疗,观察组给予腹腔镜联合胆道镜治疗。观察两组患者术中情况、术后恢复情况、手术疗效和复发情况。术中情况包括:手术时间、术中失血量。术后恢复情况包括:肛门排气时间、镇痛药使用频率、住院时间、住院费用。术后疗效包括:手术成功率、结石残留率、术后并发症。数据采用SPSS 17.0统计软件分析,计量资料采用t检验,计数资料采用χ~2检验。P<0.05为差异有统计学意义。结果观察组患者手术时间、术中出血量显著高于对照组[(94.74±20.45)min vs.(51.31±14.65)min,(46.63±15.59)ml vs.(30.76±12.24)ml],差异有统计学意义(P<0.05)。观察组术后肛门排气时间、住院时间、住院费用和镇痛药使用频率显著低于对照组[(2.04±0.62)d vs.(2.57±0.95)d,(6.57±1.42)d vs.(7.86±1.58)d,(7 351.74±322.86)元vs.(8 241.25±334.12)元,12.50%vs.26.56%],差异有统计学意义(P<0.05);两组患者手术成功率、结石残留率、并发症差异无统计学意义(P>0.05),术后随访12~18个月无复发情况。结论腹腔镜联合胆道镜治疗胆囊和胆管结石有较高的临床疗效,但应严格掌握适应证。

Objective To compare the clinical efficacy of laparoscopic joint choledochoscope for treatment of gallbladder and bile duct stones. Methods 128 patients with gallbladder stone with common bile duct calculi in our hospital from January 2013 to January 2015 were selected and divided into two groups, 64 cases in each group. The control group were given laparoscopic cholecystectomy combined endoscopic sphincterotomy nipple, observation group were given laparoscopic joint choledochoscope therapy. The intraoperative, postoperative recovery, surgical efficacy and relapse of two groups were compared. Intraoperative include: operation time, intraoperative blood loss. Postoperative recovery include: the anus exhaust time, analgesic use frequency, length of hospital stay, hospital expenses. Postoperative efficacy include: success rate of surgery, calculi residual rate and postoperative complications. Data using SPSS 17.0 statistical software analysis, measurement data using t test, counting data using χ~2 test, the difference was statistically significant(P<0.05). Results Observation group of patients with operation time, intraoperative blood loss was significantly higher than that of control group [(94.74±20.45)min vs.(51.31±14.65)min,(46.63±15.59)ml vs.(30.76±12.24)ml], the difference was statistically significant(P<0.05). Observation group anal exhaust time, postoperative hospital stay, hospital expenses and analgesic use frequency was significantly lower than control group [(2.04±0.62)d vs.(2.57±0.95)d,(6.57±1.42)d vs.(7.86±1.58)d,(7 351.74±322.86)yuan vs.(8 241.25±334.12) yuan, 12.50% vs. 26.56%], the difference was statistically significant(P<0.05). Two groups of patients with surgical success rate, calculi residual rate, complications was no statistically significant difference(P>0.05). Postoperative follow-up of 2 to 12 months to observe postoperative relapse. Conclusion Laparoscopic joint choledochoscope for treatment of gallbladder and bile duct stones has higher clinical curative effect, but must strictly grasp the indications.