| 摘要: |
| 目的 探讨4种微创手术方式治疗胆囊结石合并胆总管结石的疗效。方法 选择我院2017年1月至2018年6月收治的胆囊结石合并胆总管结石患者144例作为研究对象，其中44例行腹腔镜下胆囊切除术（LC）+腹腔镜下胆总管探查取石术（LCBDE）（T管引流），35例行LC+LCBDE （一期缝合），27例行LC+腹腔镜下经胆囊管胆总管探查取石术（LTCBDE），38例行LC+经内镜逆行胰胆管造影术（ERCP）/括约肌切开取石术（EST）。对4组患者手术情况、术后各项指标、术后早期及远期并发症等进行比较分析。结果 4组患者手术成功率、手术时间、术中出血量、肛门排气时间等比较差异均无统计学意义（P均>0.05）。LC+LCBDE （T管引流）组术后不适（腹胀、呕吐等）者比例最高、胃肠道生活质量指数得分最低，LC+LTCBDE组术后住院时间最短，LC+ERCP/EST组术后血清淀粉酶水平最高，上述指标在4组间差异均有统计学意义（P均<0.05）。4组患者术后均未出现严重并发症。术后早期，LC+LCBDE （T管引流）组出现2例胆道感染、1例T管脱落、4例高淀粉酶血症，LC+LCBDE （一期缝合）组出现4例胆漏、2例高淀粉酶血症，LC+LTCBDE组出现2例高淀粉酶血症，LC+ERCP/EST组出现8例高淀粉酶血症、2例胰腺炎。术后随访半年以上，LC+LCBDE （T管引流）组出现1例结石残留、1例结石复发、1例胆道狭窄，LC+ERCP/EST组出现4例结石复发、2例胆道狭窄。结论 上述4种微创手术方式均能有效治疗胆囊结石合并胆总管结石，其中LTCBDE创伤小、恢复快、并发症少，值得临床推广。术者需结合患者自身情况，严格把握手术指征，合理选择手术方式。 |
| 关键词: 胆囊结石 胆总管结石 腹腔镜下胆囊切除术 腹腔镜下胆总管探查取石术 腹腔镜下经胆囊管胆总管探查取石术 经内镜逆行胰胆管造影术 括约肌切开取石术 |
| DOI：10.16781/j.0258-879x.2021.11.1324 |
| 投稿时间：2020-01-21修订日期：2020-09-17 |
| 基金项目:安徽省中央引导地方科技发展专项项目（YDZX20183400004899），安徽省高校学科（专业）拔尖人才学术资助项目（gxbjZD17），皖南医学院弋矶山医院科研能力"高峰"塔尖项目（KGF2019T03），皖南医学院弋矶山医院科技创新团队"攀峰"项目（KPF2019011）. |
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| Clinical analysis of minimally invasive surgery for treating cholecystolithiasis with choledocholithiasis |
| XI Shi-hang,WANG Xiao-ming*,PAN Xuan,CHEN Peng,WANG Jun |
(Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
*Corresponding author) |
| Abstract: |
| Objective To explore the efficacy of 4 minimally invasive surgery for the treatment of cholecystolithiasis with choledocholithiasis. Methods A total of 144 patients who was diagnosed as cholecystolithiasis with choledocholithiasis in our hospital from Jan. 2017 to Jun. 2018 were selected, and randomly divided into laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE) with T tube drainage group (n=44), LC+LCBDE with primary suture group (n=35), LC+laparoscopic transcystic common bile duct exploration (LTCBDE) group (n=27), and LC+endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) group (n=38). The surgical conditions, postoperative indexes, and early and long-term complications of the 4 groups were compared and analyzed. Results There were no significant diffierences in operation success rate, operation time, intraoperative bleeding or anal exhaust time among the 4 groups (all P>0.05). The proportion of postoperative discomfort (such as bloating and vomitting) in the LC+LCBDE with T tube drainage group was significantly higher, the score of gastrointestinal quality of life index was significantly lower, the postoperative hospital stay in the LC+LTCBDE group was significantly shorter, and the postoperative serum amylase level in the LC+ERCP/EST group was significantly higher than the other 3 groups (all P<0.05). There were no serious postoperative complications in the 4 groups. In the LC+LCBDE with T tube drainage group, 2 cases had biliary tract infection, 1 had T tube detachment, and 4 had hyperamylasemia; in the LC+LCBDE with primary suture group, 4 cases had biliary leakage and 2 had hyperamylasemia; in the LC+LTCBDE group, 2 cases had hyperamylasemia; and in the LC+ERCP/EST group, 8 cases had hyperamylasemia and 2 had pancreatitis during the early postoperative period. After follow-up for more than half a year, there were 1 case of stone residue, 1 case of stone recurrence and 1 case of biliary stenosis in the LC+LCBDE with T tube drainage group; and 4 cases of stone recurrence and 2 cases of biliary stenosis in the LC+ERCP/EST group. Conclusion The 4 minimally invasive surgery methods are all effective for the treatment of cholecystolithiasis with choledocholithiasis. The LTCBDE has the advantages of minimal trauma, rapid recovery and low complication incidence, and it is worthy of clinical promotion. The surgeon should choose the best surgery according to the individual condition and surgical indications of the patients. |
| Key words: cholecystolithiasis choledocholithiasis laparoscopic cholecystectomy laparoscopic common bile duct exploration laparoscopic transcystic common bile duct exploration endoscopic retrograde cholangiopancreatography endoscopic sphincterotomy |
