“三镜”联合序贯治疗胆囊结石合并胆总管结石的临床价值探讨  

Clinical value of “three-endoscopy” sequential therapy in the treatment of patients with common bile duct stone complicated with gallbladder stone

作　　者：江帆[1] 黎建军[1] 吴国俊[1] 赵强子 邢宏松 罗刚[1] Jiang Fan;Li Jianjun;Wu Guojun;Zhao Qiangzi;Xing Hongsong;Lu Gang(Hepatobililiary Department, Wuhan Puren Hospital,Fourth Clinical Medical College Affiliated to Wuhan Science and Technology University,Wuhan 430081, China)

机构地区：[1]武汉市普仁医院、武汉科技大学附属第四临床学院肝胆外科,湖北武汉430081

出　　处：《海军医学杂志》2018年第2期129-132,138,共5页Journal of Navy Medicine

基　　金：武汉市市级临床医学项目(WX12D26)

摘　　要：目的比较"三镜"联合与"二镜"联合及传统开腹手术治疗胆囊结石合并胆总管结石的治疗效果,探讨"三镜"联合治疗胆囊结石合并胆总管结石的临床价值。方法采用随机分组的方法,将确诊为胆囊结石合并胆总管结石的患者,先筛选排除上腹部手术史、胆总管直径<0.6 cm、胆总管结石直径大于2.0 cm的病例后,再按治疗方法分成4组:即A组为传统开腹手术(TOS组)、B组为腹腔镜加胆道镜(LC+LCBDE组)、C组为腹腔镜加十二指肠镜(LC+ERCP组)和D组为"三镜"联合(LC+LCBDE+ERCP组),每组各50人。比较各组的手术成功率、残余结石率、术中失血、手术时间、引流管留置时间、术后肛门平均排气时间、术后早期下床活动时间、近期并发症例数和平均住院日。结果 D组的手术成功率与其他组比较差异无统计学意义(P>0.05)。在术中失血量[(109.6±53.7)ml]、手术时间[(117.3±53.2)h]和引流管留置时间[(5.3±0.2)d]要明显少于A组[(273.6±67.3)ml、(162.3±23.7)h、(33.6±5.3)d],引流管留置时间要明显少于A组及B组患者(P<0.05),但与C组手术患者相比差异无统计学意义(P>0.05)。在C组的患者术后残余结石发生率、术后肛门排气时间、术后下床活动时间、近期并发症例数及平均住院日均显著少于A组及C组手术组患者(P<0.05)。结论与传统开腹及"二镜"联合相比,"三镜"联合治疗胆囊结石合并胆总管结石创伤更小、并发症更少、恢复更快,减少住院时间,值得进一步推广应用。Objective To compare the therapeutic effects of＂three-endoscopy＂and＂two-endoscopy＂respectively combined with traditional open surgery in the treatment of gallbladder stone complicated with common bile duct stone,and to explore the clinical value of ＂three-endoscopy＂in the treatment of common bile duct stone complicated with gallbladder stone. Methods First,the patients with upper abdominal surgical history and those patients with common bile duct diameter smaller than 0. 6 cm and or those with stone diameter in common bile duct larger than 2. 0 cm were screened and excluded from the study. The included patients with confirmed gallbladder stone complicated with common bile duct stone were divided in accordance with different treatment methods into 4 groups： the traditional open surgery group（ or group A）,the Laparoscopy plus Bile duct endoscopy group（ or group B）,the Laparoscopy plus duodenal endoscopy group（ or group C） and the＂three-endoscopy＂group（ or group D）,each consisting of 50 patients. Comparisons were made in the success rate of surgery,residual stone rate,blood loss in the process of surgery,surgical time,drainage tube indwelling time,average air exhaust time after surgery,early ambulation time after surgery,cases of early complications and average hospitalization days between the 4 groups. Results There was no significant difference in the success rate of surgery between the＂three-endoscopy＂group and other treatment groups（P〉0. 05）. The amount of blood loss in the process of surgery[（109. 6 ± 53. 7）ml],surgical time [（117. 3 ± 53. 2） h] and drainage tube indwelling time [（5. 3 ± 0. 2） d] were significantly less than those of group A [（273. 6 ± 67. 3） ml,（162. 3 ± 23. 7） h,（33. 6 ± 5. 3） d]（ P〈0. 05）,Drainage tube indwelling time were significantly less than those of group A and group B（ P〈0. 05）,however,there were no significant differences,as compared with those of group C（ P〈0. 05）. In the ＂three-endoscopy�

关 键 词：胆囊结石 胆总管结石 腹腔镜 胆道镜 十二指肠镜 

分 类 号：R575.7[医药卫生—消化系统]