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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 403 -406. doi: 10.3877/cma.j.issn.1674-3946.2020.04.024

所属专题： 文献；

论著

两种腹腔镜术与三镜联合术治疗胆囊结石并胆总管结石的临床比较
黎万芝1,†(), 刘鸿1, 蒋丹1, 石鑫2   
  1. 1. 641000　四川省内江市中区人民医院
    2. 050031　河北医科大学第一医院
  • 收稿日期:2019-08-15 出版日期:2020-08-26
  • 通信作者: 黎万芝

Clinical comparison of two kinds of laparoscopic surgery and combined three endoscopic surgery for the treatment of gallbladder stones and common bile duct stones

Wanzhi Li1,†(), Hong Liu1, Dan Jiang1, Xin Shi2   

  1. 1. Neijiang Central District People’s Hospital 641000
    2. The First Hospital of Hebei Medical University 050031
  • Received:2019-08-15 Published:2020-08-26
  • Corresponding author: Wanzhi Li
  • About author:
    Corresponding author: Li Wanzhi, Email:
  • Supported by:
    Key Project of Medical Science Research in Hebei Province(20170476)
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引用本文：

黎万芝, 刘鸿, 蒋丹, 石鑫. 两种腹腔镜术与三镜联合术治疗胆囊结石并胆总管结石的临床比较[J]. 中华普外科手术学杂志(电子版), 2020, 14(04): 403-406.

Wanzhi Li, Hong Liu, Dan Jiang, Xin Shi. Clinical comparison of two kinds of laparoscopic surgery and combined three endoscopic surgery for the treatment of gallbladder stones and common bile duct stones[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(04): 403-406.

目的

探究两种腹腔镜术与三镜联合术治疗胆囊结石并胆总管结石的临床效果。

方法

回顾性分析2014年3月至2017年12月收治的134例胆囊结石并胆总管结石的患者，根据所采取的治疗方案不同分为A、B、C三组，A组患者采取腹腔镜与十二指肠镜联合术(n＝41)，B组患者采取腹腔镜与胆道镜联合术(n＝46)，C组患者则采取腹腔镜、十二指肠镜、胆道镜三镜联合术(n＝47)。采用SPSS20.0软件进行统计学分析，术中术后各项指标以及生活质量评分等均以(±s)描述，采用t检验；术后并发症、术后结石复发、胆总管狭窄等采用χ2检验；则P<0.05差异有统计学意义。

结果

C组患者的术中术后恢复各项指标均明显优于A、B两组(P<0.05), A组与B组上述各指标间差异均无统计学意义(P>0.05)。C组患者并发症总发生率为4.3%，低于A组(24.4%)、B组(19.6%)患者(P<0.05)。术后6个月后随访结果显示：C组患者的结石复发率与胆总管狭窄率均为(0.0%)明显低于A组(12.2%，9.8%)与B组(13.0%，8.7% )，P<0.05；术后三组患者的生活质量评分均较治疗前明显提高(P<0.05)，但C组患者的各项评分均明显优于A组与B组(P<0.05)，而A组与B组间差异无统计学意义(P>0.05)。

结论

三镜联合术治疗胆囊结石并胆总管结石的临床疗效显著，安全可行。该术式不仅降低了复发的风险，也减少了并发症发生，明显改善了患者的生活质量，值得临床进一步推广应用。

关键词: 胆囊结石病, 胆总管结石, 腹腔镜, 十二指肠镜, 疗效比较研究, 胆道镜
Objective

To investigate the clinical effects of two laparoscopic surgery and combined three endoscopic surgery for the treatment of gallbladder stones and common bile duct stones.

Methods

134 patients with gallstones and common bile duct stones admitted to our hospital from March 2014 to December 2017 were retrospectively analyzed. According to the treatment plan adopted, they were divided into three groups: A, B and C. Patients in group A underwent laparoscopic and duodenoscopy (n=41), group B underwent laparoscopic and choledochoscopy (n=46), and group C underwent laparoscopic, duodenoscopy, and choledochoscopy (n=47). The data were analyzed by SPSS20.0 software. The surgical index, postoperative recovery index and quality of life score were described by (±s) and analyzed by independent t test. Postoperative complications, postoperative calculus recurrence, and common bile duct stricture were described by (n, %), and compared with χ2 test, P<0.05 was statistically significant.

Results

The indexes of surgical and postoperative recovery in group C were significantly better than those in group A and B (P<0.05), and there was no significant difference between group A and group B (P>0.05). The total incidence of complications in group C was 4.3%, which was significant lower than that in group A (24.4%) and group B (19.6%) (P<0.05). The follow-up results after 6 months of treatment showed that the stone recurrence rate and common bile duct stenosis rate in group C (all 0%) were significant lower than those in group A (12.2%, 9.8%) and group B (13.0%, 8.7%) (P<0.05). After treatment, the quality of life scores of the three groups were significantly improved (P<0.05), but the scores of group C were significantly better than those of group A and group B (P<0.05), and there was no significant difference between group A and group B (P>0.05).

Conclusion

The clinical efficacy of combined three endoscopic surgery for the treatment of gallbladder stones and common bile duct stones is significant and safe. This procedure not only reduces the risk of recurrence, but also reduces complications, which significantly improves the quality of life of patients, and is worthy of further clinical application.

Key words: Cholecystolithiasis, Choledocholithiasis, Laparoscopes, Duodenoscopes, Comparative effectiveness research, Choledochoscopy
表1 134例胆囊结石并胆总管结石患者不同疗法三组患者基线资料[()，例]
组别 例数 年龄(岁) 性别 胆总管直径(mm) 胆总管结石数(个) 临床表现
男/女 腹痛/发热/黄疸
A组 41 43.8±13.2 19/22 1.1±0.5 1.8±1.3 18/3/20
B组 46 44.7±12.9 22/24 1.2±0.4 1.9±1.2 20/4/24
C组 47 42.3±11.4 21/26 1.1±0.3 1.6±1.4 19/6/22
F/χ2值 ? 0.951 0.093 1.366 1.109 0.912
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05
表2 134例胆囊结石并胆总管结石患者不同疗法三组患者的手术相关指标比较(±s)
组别 手术时间(min) 失血量(ml) 输液量(L) 引流时间(d)
A组 167.4±19.3 58.4±10.2 8.5±1.8 5.3±1.0
B组 174.2±20.1 53.7±11.7 8.3±1.8 5.5±1.1
C组 173.5±17.2 42.9±12.3 6.4±1.6 2.6±0.7
Ⅰ(t/P) 1.56/0.12 6.37/0.00 5.79/0.00 14.81/0.00
Ⅱ(t/P) 0.18/0.85 4.33/0.00 5.38/0.00 15.20/0.00
Ⅲ(t/P) 1.60/0.11 1.986/0.05 0.401/0.69 0.88/0.38
表3 134例胆囊结石并胆总管结石患者不同疗法三组患者术后恢复指标比较(±s)
组别 例数 住院时间(d) 排气时间(d) 下床活动时间(d)
A组 41 7.4±1.6 1.4±0.6 2.5±0.9
B组 46 7.2±1.4 1.6±0.7 2.7±1.1
C组 47 4.5±1.2 1.5±0.7 1.4±0.6
Ⅰ(t/P) ? 9.69/0.00 0.71/0.47 6.82/0.00
Ⅱ(t/P) ? 9.99/0.00 0.78/0.49 7.09/0.00
Ⅲ(t/P) ? 0.62/0.53 1.42/0.15 0.92/0.36
表4 134例胆囊结石并胆总管结石患者不同疗法三组患者术后并发症比较(例)
组别 例数 胆漏 残余结石 胆管损伤 肠梗阻 切口感染 急性胰腺炎 总发生率(%)
A组 41 1 4 1 0 2 2 10(24.4)
B组 46 1 3 1 1 2 1 9(19.6)
C组 47 0 0 1 0 1 0 2(4.3)
Ⅰ(χ2/P) ? ? ? ? ? ? ? 7.53/0.00
Ⅱ(χ2/P) ? ? ? ? ? ? ? 5.22/0.02
Ⅲ(χ2/P) ? ? ? ? ? ? ? 0.29/0.58
表5 134例胆囊结石并胆总管结石患者不同疗法三组患者治疗6个月后随访情况[例(%)]
组别 例数 结石复发率 胆总管狭窄率
A组 41 5(12.2) 4(9.8)
B组 46 6(13.0) 4(8.7)
C组 47 0(0.0) 0(0.0)
Ⅰ(χ2/P) ? 6.00/0.01 4.80/0.02
Ⅱ(χ2/P) ? 6.53/0.01 4.27/0.03
Ⅲ(χ2/P) ? 0.01/0.90 0.02/0.86
表6 134例胆囊结石并胆总管结石患者不同疗法三组患者术前和术后6个月生活质量评分比较(±s)
组别 时间 生理 心理 社会功能 物质生活
A组 术前 61.2±4.1 63.7±4.6 59.3±3.6 64.5±4.3
? 术后 73.3±4.4 75.2±4.8 73.2±3.9 77.9±5.2
B组 术前 61.7±4.2 63.9±4.7 59.8±3.8 64.9±4.5
? 术后 74.2±4.2 76.3±5.1 74.3±4.1 78.4±5.4
C组 术前 61.5±4.3 63.2±4.5 59.1±3.5 64.2±4.1
? 术后 83.4±4.5 86.7±5.0 83.8±5.2 88.2±5.1
Ⅰ(t/P) ? 10.61/0.00 10.96/0.00 10.68/0.00 9.36/0.00
Ⅱ(t/P) ? 9.86/0.00 9.93/0.00 9.77/0.00 8.99/0.00
Ⅲ(t/P) ? 0.97/0.33 1.03/0.30 1.27/0.20 0.43/0.66
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