LC联合LCHTD治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素分析  

Efficacy of LC combined with LCHTD in treatment of choledocholithiasis complicated with cholecystolithiasis and the related factors of postoperative recurrence of choledocholithiasis

作　　者：尼加提江·艾比不拉 阿力木江·阿布力米提[1] 阿里旦·艾尔肯[1] 阿依甫汗·阿汗[2] NIJIATIJIANG Aibibula;ALIMUJIANG Abulimiti;ALIDAN Aierken;AYIPUHAN Ahan(Department of General Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Hepatobiliary Echinococcidae,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院全科医学科,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院肝胆包虫科,新疆乌鲁木齐830054

出　　处：《肝胆胰外科杂志》2021年第7期419-422,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹腔镜胆囊切除(LC)联合腹腔镜胆总管切开取石T管引流术(LCHTD)治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素。方法回顾性分析2018年1月至2019年1月新疆医科大学第一附属医院93例胆总管结石合并胆囊结石患者临床资料,所有患者均给予LC联合LCHTD治疗。根据是否术后胆总管结石复发分为结石复发组(24例)和结石未复发组(69例),观察两组临床疗效、手术时间、术中出血量、总住院时间、住院费用,随访术后胆总管结石复发情况,分析术后胆总管结石复发的危险因素。结果93例患者LC联合LCHTD治疗手术成功90例,中转开腹3例。手术时间(109.4±10.6)min,术中出血量(80.2±19.1)mL,总住院时间(9.2±1.2)d,住院费用(1.9±0.4)万元。所有患者均完成随访18个月,术后胆总管结石复发24例(25.81%),平均复发时间为(10.3±2.1)个月。结石未复发组剔除中转开腹3例,单因素分析表明,结石复发组和结石未复发组患者年龄、性别、病程、结石直径差异无统计学意义(P>0.05);胆总管结石类型、结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症与胆总管结石合并胆囊结石术后胆总管结石复发相关(P<0.05);多因素非条件Logistic分析显示,结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症是胆总管结石合并胆囊结石术后胆总管结石复发的独立危险因素(P<0.05)。结论在胆总管结石合并胆囊结石患者中应用LC联合LCHTD疗效显著,术后结石复发受多种因素影响,积极干预可有效降低结石复发率。Objective To study the efficacy of laparoscopic cholecystectomy(LC)combined with laparoscopic choledocholithotomy and T-tube drainage(LCHTD)in treatment of choledocholithiasis complicated with cholecystolithiasis and the related factors of postoperative recurrence of choledocholithiasis.Methods A total of 93 patients with choledocholithiasis and cholecystolithiasis admitted in the First Affiliated Hospital of Xinjiang Medical University between Jan.2018 and Jan.2019 were retrospectively analyzed.All patients were treated with LC combined with LCHTD.According to the postoperative recurrence of choledocholithiasis,they were divided into recurrence group(n=24)and non recurrence group(n=69),Clinical efficacy,operative time,intraoperative blood loss,time and cost of hospitalization were observed.Postoperative recurrence of choledocholithiasis was followed-up,and the risk factors for postoperative recurrence of choledocholithiasis were analyzed.Results In all 93 patients,90 cases were successfully operated,and 3 cases were converted to laparotomy.The operation time was(109.4±10.6)min,intraoperative blood loss was(80.2±19.1)mL,the total hospitalization time was(9.2±1.2)d,and the cost was(1.9±0.4)ten thousand yuan.All patients were followed-up for 18 months.24 patients(25.81%)had postoperative recurrence of choledocholithiasis.The average recurrence time was(10.3±2.1)months.Three cases in non recurrencc group were excluded.Univariate analysis showed that there were no significant differences in age,gender,course of disease and stone diameter between recurrence group and non recurrence group(P>0.05).Type and number of calculi,diameter of common bile duct,lithotripsy,dilatation of common bile duct,dilatation of cystic duct and inflammation were correlated with postoperative recurrence of choledocholithiasis(P<0.05).Multivariate Logistic analysis showed that the number of calculi,diameter of common bile duct,lithotripsy,common bile duct dilatation,cystic duct dilatation,combined inflammation were independent risk facto

关 键 词：胆总管结石合并胆囊结石 腹腔镜胆囊切除术(LC) 腹腔镜胆总管切开取石T管引流术(LCHTD) 结石复发 

分 类 号：R657.4[医药卫生—外科学]