一期腹腔镜手术与分期内镜加腹腔镜手术治疗胆囊结石合并胆总管结石的临床效果和安全性比较  

One-stage laparoscopic surgery versus endoscopy plus laparoscopic surgery by stages for the treatment of cholecystolithiasis and concomitant choledocholithiasis:a comparison of clinical effect and safety

作　　者：赵今 张建 丁俊 ZHAO Jin;ZHANG Jian;DING Jun(Operating Room,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,Hubei,China;Department of Hepatobiliary Surgery,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,Hubei,China)

机构地区：[1]湖北省恩施土家族苗族自治州中心医院手术室,湖北省恩施市445000 [2]湖北省恩施土家族苗族自治州中心医院肝胆外科,湖北省恩施市445000

出　　处：《广西医学》2023年第11期1273-1277,共5页Guangxi Medical Journal

基　　金：湖北省恩施市恩施州引导性科研计划项目(2019YDKY031)。

摘　　要：目的比较一期腹腔镜手术与分期内镜加腹腔镜手术治疗胆囊结石合并胆总管结石的临床效果和安全性。方法回顾性分析121例胆囊结石合并胆总管结石患者的临床资料,根据治疗方法分为一期组69例与分期组52例。一期组患者接受一期腹腔镜手术治疗,包括腹腔镜胆囊切除术、腹腔镜胆总管探查术和一期缝合术;分期组患者接受内镜逆行胰胆管造影术及内镜下乳头括约肌切开术+择期腹腔镜胆囊切除术治疗。比较两组患者的手术成功率、残余结石率、围术期指标、社会经济指标、术后近期并发症发生率及术后远期并发症发生率。结果两组患者的手术成功率、残余结石率、手术时间、术中出血量、术后排气时间、术后近期并发症发生率及术后远期并发症发生率比较,差异均无统计学意义(均P>0.05)。一期组的术后住院时间短于分期组,住院费用少于分期组(均P<0.05)。结论一期腹腔镜手术和分期内镜加腹腔镜手术均是治疗胆囊结石合并胆总管结石安全、有效的微创手术方案,而一期腹腔镜手术的术后住院时间更短、住院费用更低。在实际临床中,需严格掌握手术适应证,根据患者具体情况选择个性化的治疗方案。Objective To compare the clinical effect and safety of one-stage laparoscopic surgery with endoscopy plus laparoscopic surgery by stages for the treatment of cholecystolithiasis and concomitant choledocholithiasis.Methods The clinical data of 121 patients with cholecystolithiasis and concomitant choledocholithiasis were retrospectively analyzed,and they were assigned to one-stage group(69 cases)or by-stages group(52 cases)according to the treatment methods.Patients in the one-stage group were treated with one-stage laparoscopic surgery,including laparoscopic cholecystectomy,laparoscopic common bile duct exploration,and one-stage suture surgery,and the by-stages group was treated with endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy plus selective laparoscopic cholecystectomy.The success rate of operation,residual stone rate,perioperative indices,social economic indices,incidence rates of postoperative short-and long-term complications in patients were compared between the two groups.Results There was no statistically significant difference in success rate of operation,residual stone rate,operation duration,intraoperative bleeding volume,postoperative exhaust time,and incidence rates of postoperative short-and long-term complications in patients between the two groups(all P>0.05).The one-stage group yielded shorter length of postoperative hospital stay,and less hospitalization expenses as compared with the by-stages group(all P<0.05).Conclusion One-stage laparoscopic surgery and endoscopy plus laparoscopic surgery by stages are all safe and effective minimally invasive surgical regimens for the treatment of cholecystolithiasis and concomitant choledocholithiasis,whereas one-stage laparoscopic surgery exhibits shorter length of postoperative hospital stay,lower hospitalization expenses.In practical clinics,surgical indication should be strictly controlled,and individual therapeutic regimens should be selected according to the specific conditions of patients.

关 键 词：胆囊结石 胆总管结石 腹腔镜胆囊切除术 腹腔镜胆总管探查术 自行脱落J管引流一期缝合术 内镜逆行胰胆管造影术 内镜下乳头括约肌切开术 一期手术 分期手术 临床效果 安全性 

分 类 号：R657.42[医药卫生—外科学]