腹腔镜术中联合十二指肠镜在治疗胆总管结石中的临床价值  

Clinical value of laparoscopy combined with duodenoscopy in the treatment of choledocholithiasis

作　　者：赵芝鑫[1] 陈耿臻[1] 许锐锐[1] 庄潮平[1] 韩慧[1] 王梅子[1] 游少钦 ZHAO Zhixin;CHEN Gengzhen;XU Ruirui;ZHUANG Chaoping;HAN Hui;WANG Meizi;YOU Shaoqin(Department of Endoscopic Vascular Surgery,the Second Affiliated Hospital of Shantou University Medical College,Guangdong Province,Shantou 515041,China)

机构地区：[1]汕头大学医学院第二附属医院普外内镜血管科,广东汕头515041

出　　处：《中国医药导报》2022年第22期92-95,共4页China Medical Herald

基　　金：广东省科技专项资金项目(2020ST066);广东省汕头市科技计划医疗卫生类别项目(190606165268435、190918115269996)。

摘　　要：目的探讨腹腔镜术中联合十二指肠镜在治疗胆总管结石中的临床价值。方法选取汕头大学医学院第二附属医院2019年7月至2021年2月收治的60例胆总管结石患者作为研究对象,按随机数字表法将其分成两组,每组各30例。研究组行腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)+内镜下鼻胆管引流术(ENBD),对照组行LC+LCBDE+T管引流。比较两组术中、术后情况。结果60例患者均成功实施手术。研究组拔管时间、住院时间均短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中出血量、胆汁引流量及胃肠恢复时间比较,差异均无统计学意义(P>0.05)。患者术后复查发现:研究组血尿淀粉酶升高率、肝功能异常率低于对照组,差异有统计学意义(P<0.05);两组术后胰腺炎、胆漏发生率比较,差异无统计学意义(P>0.05)。结论腹腔镜术中联合十二指肠镜放置鼻胆管在胆总管结石治疗中安全、有效,术后恢复快,效果确切。Objective To investigate the clinical value of laparoscopy combined with duodenoscopy in the treatment of choledocholithiasis.Methods A total of 60 patients with choledocholithiasis admitted to the Second Affiliated Hospital of Shantou University Medical College from July 2019 to February 2021 were selected as the research subjects and they were divided into two groups according to the random number table method,with 30 cases in each group.The research group underwent laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration(LCBDE)+endoscopic nasobiliary drainage(ENBD),the control group received LC+LCBDE+T tube drainage.The intraoperative and postoperative conditions of the two groups were compared.Results The extubation time and hospital stay in the study group were shorter than those in the control group,and the hospitalization costs was less than those in the control group,with statistically significant differences(P<0.05).There were no significant differences in operation time,intraoperative blood loss,bile drainage,and gastrointestinal recovery time between the two groups(P>0.05).Postoperative re-examination found that the increase rate of blood and urine amylase and abnormal liver function rate in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no statistical significance difference in the incidence of postoperative pancreatitis and bile leakage between the two groups(P>0.05).Conclusion Laparoscopic combined with duodenoscope placement of nasobiliary duct is safe and effective in the treatment of choledocholithiasis,and have quickly recover after operation with drfinite curative effect.

关 键 词：腹腔镜胆囊切除 腹腔镜胆总管探查 内镜下鼻胆管引流 T管引流 一期缝合 

分 类 号：R81[医药卫生—放射医学]