经胆囊管胆总管探查术与三镜联合治疗胆囊结石合并胆总管结石的疗效分析  

Efficacy Comparison of Laparoscopic Transcystic Common Bile Duct Exploration and Tri-scope in Treatment of Cholecystolithiasis with Common Bile Duct Stones

作　　者：曾延恒 游建[2] 金鑫 ZENG Yanheng;YOU Jian;JIN Xin(School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;Department of Hepatobiliary Surgery,Wuhan Fourth Hospital,Wuhan 430034,Hubei,China)

机构地区：[1]江汉大学医学部,湖北武汉430056 [2]武汉市第四医院肝胆外科,湖北武汉430034

出　　处：《江汉大学学报(自然科学版)》2025年第1期50-55,共6页Journal of Jianghan University:Natural Science Edition

摘　　要：目的比较腹腔镜胆囊切除术联合胆总管切开取石术+鼻胆管置入+胆管一期缝合(三镜联合)与经胆囊管胆总管探查取石术(LTCBDE)治疗胆囊结石合并胆总管结石的临床疗效。方法纳入武汉市第四医院2018年1月至2023年7月胆总管结石直径小于1 cm的胆囊结石合并胆总管结石患者108例,其中行LTCBDE手术48例作为观察组,行三镜联合手术60例作为对照组。比较两组手术时间、术后住院时间、胃肠道恢复时间、拔除腹腔引流管时间、结石残留率和术后并发症发生率等。结果两组患者在基线资料上无统计学意义,具有可比性。观察组和对照组的手术时间分别为(108.92±13.69)min和(129.5±17.17)min,术后住院时间分别为(6.79±1.74)d和(8.30±1.46)d,术后拔管时间为(3.65±0.64)d和(4.92±1.14)d,术后排气时间为(2.31±0.69)d和(3.32±0.79)d,两组比较差异具有统计学意义(P<0.05)。两组在手术成功率、结石清除率和结石复发率方面差异无统计学意义(P>0.05)。观察组未发生并发症而对照组发生6例并发症,差异无统计学意义(P>0.05)。结论腹腔镜下经胆囊管胆总管探查取石术手术时间短、术后恢复快,安全有效,适合较小的胆总管结石。Objective To compare the clinical efficacy of laparoscopic cholecystectomy combined with duodenoscopic,laparoscopic,and choledochoscopic common bile duct exploration(Tri-scope)and laparoscopic transcystic common bile duct exploration(LTCBDE)for the treatment of cholecystolithiasis with common bile duct stones.Methods 108 patients with cholecystolithiasis and common bile duct stones whose choledocholithiasis diameter was less than 1 cm were analyzed in Wuhan Fourth Hospital from January 2018 to July 2023,including 48 cases treated with LTCBDE(observation group)and 60 cases treated with Tri-scope(control group).The two groups were compared in terms of operation time,postoperative hospital stay,gastrointestinal recovery time,time to remove the abdominal drainage tube,residual stone rate,and postoperative complication rate.Results There was no statistically significant different in the base line data between the two groups of patients,and they were comparable.The operation time in the observation and control groups was(108.92±13.69)minutes and(129.5±17.17)minutes,the postoperative hospitalization time was(6.79±1.74)days and(8.30±1.46)days,the postoperative extubation time was(3.65±0.64)days and(4.92±1.14)days,the postoperative exhaust time was(2.31±0.69)days and(3.32±0.79)days,with statistically significant differences between the two groups(P<0.05).There was no statistically significant difference between the two groups in terms of surgical success rate,stone removal rate,and stone recurrence rate(P>0.05).No complications occurred in the obserration group while 6 complications occurred in the control group,there was no statistically significant difference(P>0.05).Conclusion LTCBDE is safe and effective for smaller choledochal stones with short operative time and quick postoperative recovery.

关 键 词：胆囊结石 胆总管结石 经胆囊管胆总管探查取石术(LTCBDE) 三镜联合 胆囊管途径 

分 类 号：R657.42[医药卫生—外科学]