腹腔镜胆囊切除联合胆道镜经胆囊管探查取石术与经胆总管取石术治疗胆囊合并胆总管结石的疗效比较

Comparison of efficacy between laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration in treatment of cholecystolithiasis complicated with choledocholithiasis

关键词:  腹腔镜  胆道镜  胆总管探查术

Key words:  laparoscopy  choledochoscopy  common bile duct exploration

摘要:

目的比较腹腔镜胆囊切除联合胆道镜经胆囊管探查取石术与经胆总管取石术治疗胆囊合并胆总管结石的疗效。方法回顾性对比分析腹腔镜联合胆道镜经胆囊管探查取石术（观察组，n=68）和腹腔镜经胆总管探查取石术（对照组，n=69）治疗胆囊结石合并胆总管结石的临床疗效。对两组的手术时间、术中出血量、术后恢复相关指标、住院总金额、术前与术后胃肠病生活质量指数（GIQLI）和术后并发症发生率等进行比较。结果两组手术成功率、一次结石清除率、术中出血量、术后并发症发生率、结石复发率均无差异(P＞0.05)。观察组手术时间[(146.81±48.62)min vs (175.21±52.04)min]、术后下床时间[(22.89±3.44)h vs (31.73±3.80)h]、术后首次肛门排气时间[(22.51±3.64)h vs (8.02±2.81)h]、术后住院时间[(8.64±1.19)d vs (10.81±2.20)d]均短于对照组（均P＜0.05），平均住院费用[(27377±11203)元 vs (35241±11843)元]也低于对照组（P＜0.05）。结论腹腔镜联合胆道镜经胆囊管探查取石术治疗胆囊合并胆总管结石术后恢复较快，生活质量较好，安全有效，值得推广。

Abstract:

ObjectiveTo compare the therapeutic effect between laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration(LTCBDE) and laparoscopic common bile duct exploration(LCBDE) in treatment of cholecystolithiasis complicated with choledocholithiasis. MethodsClinical data of 137 patients with cholecystolithiasis complicated with choledocholithiasis treated in Shanghai Putuo Hospital from January 2019 to December 2021 were retrospective analyzed, including 68 cases treated with laparoscopic cholecystectomy plus chole-dochoscopic choledocholithotomy(study group) and 69 cases treated with laparoscopic chole-docholithotomy(control group). The clinical efficacy, operation time, intraoperative blood loss, postoperative recovery related indicators, total hospitalization expenses, preoperative and postoperative gastrointestinal disease, quality of life index(GIQLI) and postoperative complications were compared between two groups. ResultsThere were no significant differences in the success rate of operation, the stone clearance rate at one time, the amount of intraoperative bleeding, the incidence of postoperative complications, and the recurrence rate of stones between the two groups(all P>0.05). The operation time in the study group [(146.81±48.62)min vs (175.21±52.04)min], postoperative bedrest time [(22.89±3.44)h vs (31.73±3.80)h], postoperative anal exhaust time [(22.51±3.64)h vs (8.02±2.81)h], and postoperative length of hospital stay [(8.64±1.19)d vs (10.81±2. 20)d] were shorter than those in the control group(all P<0.05); the average hospitalization cost [(27377±11203) yuan vs (35241±11843) yuan] was lower than that of the control group(P<0.05). ConclusionLaparoscopy plus choledochoscopy for treatment of chole-cystolithiasis complicated with choledocholithiasis has a quick recovery, good quality of life, safety and effectiveness, and is worth promoting clinically.