腹腔镜联合胆道镜经胆囊管治疗胆总管结石的有效性与安全性  

Efficacy and safety of laparoscope combined with choledochoscope through cystic duct in the treatment of choledocholithiasis

作　　者：周绍荣 张鹏[2] 焦兰农[1] 陈秋兰[1] 姚建根[1] 江涛[1] ZHOU Shaorong;ZHANG Peng;JIAO Lannong;CHEN Qiulan;YAO Jiangen;JIANG Tao(Department of General Surgery,Taizhou Hospital of Traditional Chinese Medicine,Taizhou 225300,Jiangsu,China)

机构地区：[1]泰州市中医院普外科,江苏泰州225300 [2]泰州职业技术学院

出　　处：《上海医学》2022年第2期105-109,共5页Shanghai Medical Journal

摘　　要：目的探讨腹腔镜联合胆道镜经胆囊管治疗胆总管结石的有效性与安全性。方法回顾分析2015年1月—2019年12月间在泰州市中医院行手术治疗的55例慢性结石性胆囊炎合并胆总管结石患者的临床资料,根据不同的手术方式,分为腹腔镜下胆囊切除术+经胆囊管行胆总管取石术(LTCBDE)组(26例)和腹腔镜下胆囊切除术+胆总管切开探查术(LCCBDE)组(29例)。比较两组患者手术相关的临床指标和术后消化道症状分级评分,以及术后并发症发生情况。结果LTCBDE组术中出血量显著少于LCCBDE组(P<0.05),术后首次排气时间、腹腔引流时间、术后住院时间均显著短于LCCBDE组(P值均<0.05)。两组间手术时间的差异无统计学意义(P>0.05)。LTCBDE组术后消化道症状分级评分总分为(2.65±1.41)分,显著低于LCCBDE组的(4.24±2.06)分(P<0.05)。LTCBDE组食欲差、便秘、硬粪的评分均显著低于LCCBDE组(P值均<0.05),两组间腹泻、脐周痛、下腹胀、排气增多评分的差异均无统计学意义(P值均>0.05)。LCCBDE组术后发生胆漏1例,予以保守治疗后好转出院,两组患者术后并发症发生率的差异无统计学意义(P>0.05)。两组患者术中均无中转行开腹手术,LTCBDE组有1例患者因取石困难而改行LCCBDE术。所有患者均痊愈出院,出院后随访3个月,无相关并发症发生。结论LTCBDE治疗胆总管结石具有创伤小、安全、患者痛苦小、术后胃肠道功能恢复快等优点,且保留了胆道系统的完整性,使微创外科的优势最大化,从而提高患者的生活质量。Objective To investigate the efficacy and safety of laparoscope combined with choledochoscope through cystic duct in treatment of choledocholithiasis.Methods Clinical data of 55 patients with chronic calculous cholecystitis and choledocholithiasis treated surgically in Taizhou Chinese Medicine Hospital,between January 2015 and December 2019 were retrospectively analyzed.Laparoscopic transcystic common bile duct exploration(LTCBDE)was performed in 26 patients,and laparoscopic choledochotomy for common bile duct exploration(LCCBDE)was carried out in 29 patients.Surgical related indexes,postoperative gastrointestinal symptom scores and complications were recorded.Results Intraoperative blood loss in LTCBDE group was significantly less than that in LCCBDE group(P<0.05).The first postoperative exhaust time,abdominal drainage time and postoperative hospital stay in LTCBDE group were significantly shorter than those in LCCBDE group(all P<0.05).There was no significant difference in operation time between the two groups(P>0.05).The total score of postoperative gastrointestinal symptoms in LTCBDE group was significantly lower than that in LCCBDE group(2.65±1.41 vs.4.24±2.06,P<0.05).The scores of poor appetite,constipation and hard feces in LTCBDE group were also significantly lower than those in LCCBDE group(all P<0.05).There were no significant differences in the scores of diarrhea,periumbilical pain,lower abdominal distension,or increased exhaust between the two groups(all P>0.05).Bile leakage occurred in one patient after LCCBDE,which was rehabilitated by conservative treatment.There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).There was no case of conversion to laparotomy.LTCBDE was converted to LCCBDE in one patient because of the difficulty in stone extraction.All patients recovered after operative treatment,and no related complications occurred during 3-month follow-up.Conclusion LTCBDE has the advantages of less trauma,better safety,less pain and ra

关 键 词：腹腔镜联合胆道镜 胆囊管 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]