摘要
目的探讨胆囊结石合并胆总管结石采取腹腔镜与胆道镜联合(双镜联合)治疗的临床疗效。方法纳入新沂市人民医院2013年6月至2016年6月确诊为胆囊结石合并胆总管结石的病人76例,其中采用双镜联合治疗组38例,行开放手术治疗组38例,收集并比较两组病人术前、术中及术后的资料,并对纳入研究病例进行3个月至3年随访。观察两组术中出血量、手术时间、术后下床活动时间、术后排气时间、疼痛视觉模拟评分(VAS评分)、术后并发症、术后结石残留、胆管炎复发、结石复发等指标以评价治疗效果。结果双镜联合治疗组术中出血量(69±35) mL、术后排气时间(32±12) h、术后下床活动时间(1.4±0.3) d、VAS评分(3.2±1.1)、住院时间(14.5±3.6) d、术后并发症发生率(7.9%),与开放手术治疗组的(175±65) mL、(85±21) h、(3.5±1.1) d、(6.8±2.0)、(18.2±5.6) d、(26.3%)比较,差异有统计学意义(P<0.05)。术后4周行经T管胆道造影发现开放手术治疗组结石残留3例,双镜联合治疗组无残留。术后随访3月至3年,开放手术治疗组3例胆总管结石复发,双镜联合治疗组无结石复发。开放手术治疗组3例发生胆管炎,双镜联合治疗组无胆管炎发生。结论腹腔镜与胆道镜联合治疗胆囊结石合并胆总管结石与传统开放手术相比,具有恢复快、创伤小、并发症少、住院时间短等优点,安全有效。
Objective To investigate the clinical efficacy of the combination of laparoscopic and choledochoscopic technique(combination of scopes)in the treatment of biliary gallbladder stones combined with common bile duct stones.Methods Seventy-six patients diagnosed with gallbladder and common bile duct stones in Xinyi People s Hospital from June 2013 to June 2016 were enrolled in this study,38 patients treated with laparoscopic and choledochoscopic technique,38 patients treated with open surgery.Preoperative,intraoperative and postoperative data were collected and compared between 2 groups,and all the patients were followed up for 3 months to 3 years.The operative time,blood loss,postoperative exhaust time and postoperative ambulation time,VAS scores,postoperative complications,postoperative residual stones,stone recurrence,recurrent cholangitis and other indicators were collected and analysised.Results In double endoscopic group,blood loss(69±35)mL,postoperative discharge time(32±12)h,postoperative ambulation time(1.4±0.3)d,VAS score(3.2±1.1),hospital stay days(14.5±3.6)d,incidence of postoperative complications(7.9%),compared with that in open group is(175±65)mL,(85±21)h,(3.5±1.1)d,VAS score(6.8±2.0),(18.2±5.6)d and(26.3%)respectively,the difference was statistically significant(P<0.05).Residual stones were found in 3 patients of the open group through the T-tube cholangiography 4 weeks after operation,and there is no stone residue in laparoscopic group.After followed up for 3 months to 3 years,bile duct stone recurrence were found 3 patients in open surgery group,and there is no stone recurrence in laparoscopic group;and there is 3 patiens with cholangitis recurrent in open operation group,of the patiens in laparoscopic group had no recurrence.Conclusion Compared with traditional open surgery,laparoscopic and endoscopic treatment biliary gallstone biliary calculi has many advantage,such as less trauma,quicker recovery,fewer complications,shorter hospital stay,safe and effective.
作者
张同领
王阳龙
唐献金
徐焕成
卜震
ZHANG Tongling;WANG Yanglong;TANG Xianjin;XU Huancheng;BU Zhen(Department of Minimally Invasive Surgery,Xinyi People's Hospital,Xinyi,Jiangsu 221400,China)
出处
《安徽医药》
CAS
2019年第4期797-800,共4页
Anhui Medical and Pharmaceutical Journal
