腹腔镜联合胆道镜经胆囊管胆总管探查取石在胆囊结石合并胆总管结石中的疗效  

Clinical effect of laparoscopic and choledochoscopic transcystic common bile duct exploration in the treatment of cholecystolithiasis combined with choledocholithiasis

作　　者：黄民 唐鑫 艾先兰 唐彪 HUANG Min;TANG Xin;AI Xianlan;TANG Biao(Department of Hepatobiliary and Pancreatic Surgery,Yongzhou Central Hospital,Yongzhou,Hunan 425000,China)

机构地区：[1]永州市中心医院北院肝胆胰外科,湖南永州425000

出　　处：《肝胆胰外科杂志》2024年第12期729-734,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹腔镜联合胆道镜经胆囊管胆总管探查取石治疗胆囊结石合并胆总管结石的临床效果与安全性。方法回顾性分析2021年1月至2023年6月永州市中心医院北院收治的143例胆囊结石合并胆总管患者的临床资料,其中观察组行腹腔镜联合胆道镜经胆囊管胆总管探查取石(LTCBDE组,n=70),对照组行腹腔镜胆总管探查取石(LCBDE组,n=73)。比较两组结石清除率、手术时间、术中出血量、肛门排气时间、术后下床时间、术后住院时间、术后疼痛评分、术后并发症等。结果观察组的手术时间[(79.43±9.26)min vs(94.56±8.41)min]、术后下床时间[(24.74±3.00)h vs(37.85±2.95)h]、肛门排气时间[(26.31±3.04)h vs(34.44±2.35)h]、术后住院时间[(5.91±0.78)d vs(8.55±0.99)d]均明显短于对照组(P<0.05),两组术中出血量、结石清除率、总体并发症发生率方面差异无统计学意义(P>0.05);观察组术后疼痛评分明显低于对照组(P<0.05)。结论LTCBDE治疗胆囊结石合并胆总管结石与LCBDE的安全性和有效性类似,并且术前根据影像学检查预判胆囊管直径,术中可灵活选择胆囊管切口形式,进一步提升其优势。Objective To evaluate the clinical effect of laparoscopic and choledochoscopic transcystic common bile duct exploration(LTCBDE)in the treatment of cholecystolithiasis combined with choledocholithiasis.Methods The clinical data of 143 patients with cholecystolithiasis combined with choledocholithiasis treated in Yongzhou Central Hospital from Jan.2021 to Jun.2023 were retrospectively analyzed.Among 143 patients,70 were assigned to the observation group,and LTCBDE was performed,while 73 were assigned to the control group,and laparoscopic common bile duct exploration(LCBDE)was performed.The stone clearance rate,operative time,intraoperative blood loss,anal deflation time,postoperative out-of-bed time,postoperative hospitalization time,postoperative pain score,and postoperative complications were compared between the two groups.Results The operation time[(79.43±9.26)min vs(94.56±8.41)min],postoperative out-of-bed time[(24.74±3.00)h vs(37.85±2.95)h],anal exhaust time[(26.31±3.04)h vs(34.44±2.35)h]and postoperative hospitalization time[(5.91±0.78)d vs(8.55±0.99)d]in the observation group were shorter than those in the control group(P<0.05).Additionally,the postoperative pain score in the observation group were lower than that in the control group(P<0.05).However,there was no significant difference in intraoperative blood loss,stone clearance rate or postiperative complication rate between the two groups(P>0.05).Conclusion For treatment of cholecystolithiasis combined with choledocholithiasis,LTCBDE is as safe and effective as LCBDE.Furthermore,the diameter of the cystic duct can be predicted according to the preoperative imaging,allowing flexible selection of the incision form of the cystic duct during LTCBDE,which adatability enhances the method’s advantages.

关 键 词：腹腔镜手术 胆道镜手术 胆总管结石 胆囊结石 经胆囊管胆总管探查 

分 类 号：R657.4[医药卫生—外科学]