腹腔镜下经胆囊管胆总管探查术与腹腔镜胆总管探查术治疗胆总管结石的疗效比较: 一项前瞻性随机对照研究

Efficacy comparison of laparoscopic combined with choledochoscopic treatment for common bile duct stones via the cystic duct approach versus the common bile duct approach： a prospective randomized controlled trial

关键词:  腹腔镜  胆道镜  胆囊管  胆总管探查术  前瞻性随机对照研究

Key words:  laparoscopy  choledochoscopy  cystic duct  common bile duct exploration  prospective randomized controlled trial

摘要:

目的从安全性、有效性两方面比较腹腔镜下经胆囊管胆总管探查术(laparoscopic transcystic common bile duct exploration, LTCBDE)与腹腔镜胆总管探查术(laparoscopic common bile duct exploration, LCBDE)治疗胆总管结石治疗的疗效。 方法采用前瞻随机对照试验方法选取同济大学附属普陀人民医院普外科2022年6月—2024年1月53例胆总管结石患者，将这些患者根据数字表随机方法进行随机分组，分为研究组(LTCBDE，n=26)和对照组(LCBDE，n=27)，两组均行腹腔镜下胆囊切除术；比较两组的手术时间、术后住院天数、住院总金额、术前与术后胃肠病生活质量指数(gastrointestinal quality of life index)和术后并发症发生率等。 结果两组患者的单次结石清除成功率、术中出血量、术后并发症发生率和胆总管结石复发率差异均无统计学意义；研究组手术平均时间[(145.80±47.60) min vs (174.20±51.22) min]、术后离床活动时间[(22.88±3.42) h vs (31.72±3.71) h]，术后首次肛门排气时间[(22.51±3.65) h vs (28.02±2.81) h]，术后住院天数[(8.44±1.19) d vs (10.76±2.13) d]，住院金额[(28 241±11 300)元 vs (36 233±12 220)元]均低于对照组。 结论LTCBDE联合腹腔镜下胆囊切除术治疗胆总管结石术后恢复较快，生活质量高、有效、安全，值得推广。

Abstract:

ObjectiveTo compare the efficacy and safety of laparoscopic trans-cystic bile duct exploration(LTCBDE) and laparoscopic common bile duct exploration(LCBDE) for the treatment of common bile duct stones. MethodsA prospective randomized controlled trial was conducted. A total of 53 patients with common bile duct stones treated in the Department of General Surgery at Putuo Peoples Hospital, affiliated with Tongji University, between June 2022 and January 2024 were selected. The patients were randomly assigned into two groups using a random number table： the study group(n=26) underwent LTCBDE, while the control group(n=27) underwent LCBDE. The two groups were compared in terms of operative time, postoperative hospital stay, total hospitalization cost, preoperative and postoperative gastrointestinal quality of life index(GIQLI), and incidence of postoperative complications. ResultsThere was no significant differences in the success rate of single-session stone clearance, intraoperative blood loss, incidence of postoperative complications, and recurrence rate of common bile duct stones between the two groups. However, compared with those in the control group, the study group had a significantly shorter operative time [(145.80±47.60) minutes vs (174.20±51.22) minutes], earlier postoperative mobilization [(22.88±3.42) hours vs (31.72±3.71) hours), shorter time to first postoperative flatus [(22.51±3.65) hours vs (28.02±2.81) hours], shorter postoperative hospital stay [(8.44±1.19) days vs (10.76±2.13) days], and lower hospitalization costs [(28 241±11 300) CNY vs (36 233±12 220) CNY]. ConclusionLTCBDE for the treatment of common bile duct stones results in faster postoperative recovery, higher quality of life, and is both effective and safe, making it a procedure worth promoting.