2种方法治疗胆囊结石并胆总管结石的临床分析  

Clinical Analysis of Two Methods in the Treatment of Cholecystolithiasis Combined with Choledocholithiasis

作　　者：郭志唐 龙奎[1] 陈章彬 廖伟然 戈佳云[1,2] 张威 GUO Zhitang;LONG Kui;CHEN Zhangbin;LIAO Weiran;GE Jiayun;ZHANG Wei(Dept.of Hepatobiliary and Pancreatic Surgery,The 2nd Affiliated Hospital,Kunming Medical University,Kunming Yunnan 650101;Dept.of Surgery,The 3rd Affiliated Hospital,Yunnan University of Traditional Chinese Medicine,Kunming Yunnan 650500;Dept.of General Surgery,Nujiang People’s Hospital,Nujiang Yunnan 673200,China)

机构地区：[1]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101 [2]云南中医药大学第三附属医院外科,云南昆明650500 [3]怒江州人民医院普通外科,云南怒江673200

出　　处：《昆明医科大学学报》2024年第9期144-150,共7页Journal of Kunming Medical University

基　　金：昆明医科大学第二附属医院院内临床研究资助项目(ynIIT2021013)。

摘　　要：目的比较腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查一期缝合术(LBEPS)及LC+腹腔镜经胆囊管胆总管探查术(LTCBDE)2种术式的临床治疗效果。方法回顾性分析2018年1月至2023年6月昆明医科大学第二附属医院肝胆胰外科收治的64例采用LC+LBEPS及LC+LTCBDE治疗的胆囊结石并胆总管结石患者的临床资料,其中35例行LC+LBEPS,29例行LC+LTCBDE,比较2组患者的手术时间、术中出血量、腹腔引流时间、手术成功率、总住院时间、总住院费用、手术并发症发生率及结石复发率。结果2组患者基线资料、手术成功率及术后并发症发生率比较差异无统计学意义(P>0.05);LC+LBEPS组手术时间[160.00(150.00,167.50)]min vs[114.00(95.00,126.00)]min、术中出血量[30.00(27.40,40.00)]mL vs[22.00(20.00,25.00)]mL、腹腔引流时间[5.00(5.00,6.00)]d vs[3.00(3.00,4.00)]d、总住院时间(8.31±1.98)d vs(6.14±2.07)d及总住院费用[2.82(2.32,3.44)]万元vs[1.68(1.61,1.86)]万元均高于LC+LTCBDE组,差异有统计学意义(P<0.05)。结论LC+LBEPS及LC+LTCBDE均是治疗胆囊结石并胆总管结石的2种免T管有效治疗方式,但LC+LTCBDE手术时间、术中出血量、腹腔引流时间、总住院时间、总住院费用更低,临床治疗效果更优,在满足手术适应症的前提下可优先选择。Objective To compare the clinical therapeutic effects of Laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration and primary suture(LBEPS)and LC+laparoscopic common bile duct exploration through cystic duct(LTCBDE).Methods The clinical data of 64 patients with cholecystolithiasis complicated with choledocholithiasis treated by LC+LBEPS and LC+LTCBDE from January 2018 to June 2023 were analyzed retrospectively,including 35 patients with LC+LBEPS and 29 patients with LC+LTCBDE.Besides,the operation time,intraoperative bleeding,abdominal drainage time,operation success rate,total hospitalization time,total hospitalization expenses,surgical complications and stone recurrence rate between the two groups were compared.Results There was no significant difference in baseline data,surgical success rate and postoperative complication rate between these two groups(P>0.05).The operation time,blood loss,abdominal drainage time,total hospitalization time and total hospitalization cost in the LC+LBEPS group were significantly higher than those in LC+LTCBDE group(P<0.05).Conclusions LC+LBEPS and LC+LTCBDE are two effective treatment methods for cholecystolithiasis complicated with choledocholithiasis without T tube.However,LC+LTCBDE has lower operation time,intraoperative bleeding,abdominal drainage time,total hospitalization time and total hospitalization cost,as well as better clinical treatment effect,so that it can be preferred on the premise of meeting surgical indications.

关 键 词：腹腔镜 胆道镜 胆囊结石病 胆总管结石病 胆囊切除术 胆总管探查术 

分 类 号：R657.3[医药卫生—外科学]