腹腔镜联合胆道镜下胆囊切除+胆总管切开取石术治疗胆囊结石合并胆总管结石的疗效分析  

Efficacy analysis of laparoscopic cholecystectomy combined with choledochoscopic choledocholithotomy for the treatment of cholecystolithiasis with choledocholithiasis

作　　者：张良斌 ZHANG Liang-bin(General Department of Pediatric Surgery,Wulian County People's Hospital,Rizhao 262300,China)

机构地区：[1]五莲县人民医院普外小儿外科,262300

出　　处：《中国实用医药》2023年第12期9-12,共4页China Practical Medicine

摘　　要：目的 探析腹腔镜联合胆道镜下胆囊切除+胆总管切开取石术治疗胆囊结石合并胆总管结石的疗效。方法 74例胆囊结石合并胆总管结石患者,随机分为甲组和乙组,各37例。甲组患者采用常规开腹手术治疗,乙组患者采用腹腔镜联合胆道镜下胆囊切除+胆总管切开取石术治疗。比较两组患者手术相关指标、术后并发症发生情况、结石残余率、治疗满意度。结果 乙组患者的手术时间(112.34±5.68)min、肛门排气时间(1.58±0.31)d、下床活动时间(1.29±0.42)d、住院时间(10.49±2.28)d均明显短于甲组的(126.27±5.86)min、(2.74±0.58)d、(2.23±0.44)d、(15.68±2.36)d,术中出血量(112.87±5.59)ml明显少于甲组的(130.67±5.36)ml,差异具有统计学意义(P<0.05)。乙组患者的术后并发症发生率为5.40%(2/37),低于甲组的21.62%(8/37),差异具有统计学意义(χ^(2)=4.163,P=0.041<0.05)。甲组和乙组结石残余率分别为8.11%(3/37)、5.40%(2/37),乙组结石残余率略低于甲组,但差异无统计学意义(χ^(2)=0.214,P=0.643>0.05)。乙组患者的治疗总满意度91.89%显著高于甲组的62.16%,差异具有统计学意义(χ^(2)=9.240,P=0.002<0.05)。结论 胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜下胆囊切除+胆总管切开取石术治疗的效果确切,结石残余率低,手术相关指标改善明显,且术后并发症发生率低,推荐使用。Objective To discuss the efficacy of laparoscopic cholecystectomy combined with choledochoscopic choledocholithotomy for the treatment of cholecystolithiasis with choledocholithiasis.Methods A total of 74 patients with cholecystolithiasis and choledocholithiasis were randomly divided into group A and group B,with 37 cases in each group.Patients in group A were treated with conventional open surgery,and patients in group B were treated with laparoscopic cholecystectomy and choledochoscopic choledocholithotomy.The surgery-related indexes,postoperative complications,residual stone rate and treatment satisfaction were compared between the two groups.Results Group B had operating time of(112.34±5.68)min,anal exhaust time of(1.58±0.31)d,ambulation time of(1.29±0.42)d and hospitalization time of(10.49±2.28)d,which were significantly shorter than those of(126.27±5.86)min,(2.74±0.58)d,(2.23±0.44)d and(15.68±2.36)d in group A;the intraoperative blood loss of(112.87±5.59)ml in group B was significantly less than that of(130.67±5.36)ml in group A;the differences were statistically significant(P<0.05).The incidence of postoperative complications was 5.40%(2/37)in group B,which was lower than that of 21.62%(8/37)in group A,and the difference was statistically significant(χ^(2)=4.163,P=0.041<0.05).The residual stone rate of group A and group B were 8.11%(3/37)and 5.40%(2/37),respectively.The residual stone rate of group B was slightly lower than that of group A,but the difference was not statistically significant(χ^(2)=0.214,P=0.643>0.05).The total satisfaction of 91.89%in group B was significantly higher than that of 62.16%in group A,and the difference was statistically significant(χ^(2)=9.240,P=0.002<0.05).Conclusion Laparoscopic cholecystectomy combined with choledochoscopic choledocholithotomy for the treatment of patients with cholecystolithiasis and choledocholithiasis is recommended for its definite effect,low residual stone rate,significant improvement of surgery-related indexes,and low incidence of postope

关 键 词：胆囊结石 胆总管结石 腹腔镜 胆道镜 胆囊切除术 胆总管切开取石术 

分 类 号：R657.4[医药卫生—外科学]