腹腔镜胆囊切除联合胆道镜经胆囊管探查取石术与经胆总管取石术治疗胆囊合并胆总管结石的疗效比较  

Comparison of efficacy between laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration in treatment of cholecystolithiasis complicated with choledocholithiasis

作　　者：冯矗[1] 罗浩[1] 左亮[1] 刘古月[1] 陈飞 李晓宇 FENG Chu;LUO Hao;ZUO Liang;LIU Guyue;CHEN Fei;LI Xiaoyu(Department of general surgery,Shanghai Putuo District People's Hospital,Shanghai 200060,China)

机构地区：[1]上海市普陀区人民医院普外科,上海200060

出　　处：《同济大学学报（医学版）》2023年第1期105-109,共5页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金青年项目(82103481);上海市2020年度“科技创新行动计划”自然科学基金项目(20ZR1450200);2022年度上海市普陀区卫生健康系统科技创新项目(ptkwws202211);上海市普陀区人民医院院级课题(2021rmlcky03)。

摘　　要：目的 比较腹腔镜胆囊切除联合胆道镜经胆囊管探查取石术与经胆总管取石术治疗胆囊合并胆总管结石的疗效。方法 回顾性对比分析腹腔镜联合胆道镜经胆囊管探查取石术(观察组,n=68)和腹腔镜经胆总管探查取石术(对照组,n=69)治疗胆囊结石合并胆总管结石的临床疗效。对两组的手术时间、术中出血量、术后恢复相关指标、住院总金额、术前与术后胃肠病生活质量指数(GIQLI)和术后并发症发生率等进行比较。结果 两组手术成功率、一次结石清除率、术中出血量、术后并发症发生率、结石复发率均无差异(P>0.05)。观察组手术时间[(146.81±48.62) min vs(175.21±52.04) min]、术后下床时间[(22.89±3.44) h vs(31.73±3.80) h]、术后首次肛门排气时间[(22.51±3.64) h vs(8.02±2.81) h]、术后住院时间[(8.64±1.19) d vs(10.81±2.20) d]均短于对照组(均P<0.05),平均住院费用[(27 377±11 203)元vs(35 241±11 843)元]也低于对照组(P<0.05)。结论 腹腔镜联合胆道镜经胆囊管探查取石术治疗胆囊合并胆总管结石术后恢复较快,生活质量较好,安全有效,值得推广。Objective To compare the therapeutic effect between laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration(LTCBDE) and laparoscopic common bile duct exploration(LCBDE) in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods Clinical data of 137 patients with cholecystolithiasis complicated with choledocholithiasis treated in Shanghai Putuo Hospital from January 2019 to December 2021 were retrospective analyzed, including 68 cases treated with laparoscopic cholecystectomy plus chole-dochoscopic choledocholithotomy(study group) and 69 cases treated with laparoscopic chole-docholithotomy(control group). The clinical efficacy, operation time, intraoperative blood loss, postoperative recovery related indicators, total hospitalization expenses, preoperative and postoperative gastrointestinal disease, quality of life index(GIQLI) and postoperative complications were compared between two groups. Results There were no significant differences in the success rate of operation, the stone clearance rate at one time, the amount of intraoperative bleeding, the incidence of postoperative complications, and the recurrence rate of stones between the two groups(all P>0.05). The operation time in the study group [(146.81±48.62) min vs(175.21±52.04) min], postoperative bedrest time [(22.89±3.44) h vs(31.73±3.80) h], postoperative anal exhaust time [(22.51±3.64) h vs(8.02±2.81) h], and postoperative length of hospital stay [(8.64±1.19) d vs(10.81±2. 20) d] were shorter than those in the control group(all P<0.05);the average hospitalization cost [(27 377±11 203) yuan vs(35 241±11 843) yuan] was lower than that of the control group(P<0.05). Conclusion Laparoscopy plus choledochoscopy for treatment of chole-cystolithiasis complicated with choledocholithiasis has a quick recovery, good quality of life, safety and effectiveness, and is worth promoting clinically.

关 键 词：腹腔镜 胆道镜 胆总管探查术 

分 类 号：R657.4[医药卫生—外科学]