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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 (05) : 530 -533. doi: 10.3877/cma.j.issn.1674-3946.2020.05.027

所属专题： 文献；

论著

两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析
练远书1, 黄高1,†(), 陆开艺1, 文明波1   
  1. 1. 541002　桂林，解放军联勤保障部队第九二四医院肝胆胰外科
  • 收稿日期:2019-08-26 出版日期:2020-10-26
  • 通信作者: 黄高

A comparative study of LCBDE and LBEPS in the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter

Yuanshu Lian1, Gao Huang1,†(), Kaiyi Lu1, Mingbo Wen1   

  1. 1. Hepatobiliary and Pancreatic Surgery, 924 Hospital of Joint Logistics Support Force of PLA, Guilin 541002, Chian
  • Received:2019-08-26 Published:2020-10-26
  • Corresponding author: Gao Huang
  • About author:
    Corresponding author: Huang Gao, Email:
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引用本文：

练远书, 黄高, 陆开艺, 文明波. 两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析[J]. 中华普外科手术学杂志(电子版), 2020, 14(05): 530-533.

Yuanshu Lian, Gao Huang, Kaiyi Lu, Mingbo Wen. A comparative study of LCBDE and LBEPS in the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 530-533.

目的

探究腹腔镜胆总管切开探查取石并T管外引流术(LCBDE)与腹腔镜胆总管切开探查取石并一期缝合术(LBEPS)对胆总管直径≥1.0 cm结石患者的治疗效果。

方法

回顾性分析2015年1月至2019年1月胆总管直径≥1.0 cm结石患者100例资料，按不同术式分为LCBDE组52例、LBEPS组48例。采用SPSS20.0统计软件进行分析处理。术中术后各项指标、胆管压力、生活质量、应激反应比较采用(±s)描述，独立样本t检验；术后并发症、取石成功率、结石残余率、复发率比较采用χ2检验，P<0.05为具有统计学意义。

结果

LBEPS组患者引流时间、下床活动时间、可进食时间、胃肠道功能恢复时间、住院时间均少于LCBDE组(P<0.05)。术后LBEPS组患者生活质量评分高于LCBDE组，胆管压力低于LCBDE组(P<0.05)。LBEPS组患者术后应激反应程度低于LCBDE组(P<0.05)。LCBDS组患者取石成功率高于LCBDE组，结石残余率、复发率均低于LBEPE组，但两组比较差异无统计学意义(P>0.05)。LBEPS组患者术后并发症发生率为3.9%(2/52)低于LCBDE组18.8%(9/48)，P<0.05。

结论

LBEPS治疗胆总管直径≥1.0cm结石可促进患者术后快速恢复，减少患者手术机体应激反应，取石成功率较高，且术后并发症发生率较低，安全性较高。

关键词: 胆总管结石, 腹腔镜, 腹腔镜胆总管切开探查取石并T管外引流术, 腹腔镜胆总管切开探查取石并一期缝合术, 疗效比较研究
Objective

To study the effect of laparoscopic common bile duct exploration with T tube drainage (LCBDE) and laparoscopic common bile duct exploration with primary suture(LBEPS) for the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter.

Methods

From January 2015 to January 2019, 100 patients with calculi of common bile duct diameter ≥1.0 cm admitted to our hospital were retrospectively analyzed. According to different operative methods, 52 patients were divided into LCBDE group and 48 patients were divided into LBEPS group. SPSS20.0 statistical software was used for analysis. Intraoperative and postoperative indicators, bile duct pressure, quality of life, and stress response were described by (±s), and compared with independent t test. χ2 test was used to compare postoperative complications, success rate of stone extraction, residual stone rate and recurrence rate. P<0.05 was considered statistically significant.

Results

Patients in the LBEPS group had shorter drainage time, activity time, feeding time, recovery time of gastrointestinal function and hospitalization time than those in the LCBDE group (P<0.05). Postoperative quality of life score in LBEPS group was higher than that in LCBDE group, and bile duct pressure was lower than that of LCBDE group (P<0.05). The degree of postoperative stress response in the LBEPS group was lower than that in the LCBDE group (P<0.05). The success rate of stone extraction in the LCBDS group was higher than that in the LCBDE group, and the residual and recurrence rates of stones were lower than those in the LBEPE group, but there was no statistical difference between the two groups (P>0.05). The incidence of postoperative complications in the LBEPS group was 3.9% (2/52), which was lower than that in the LCBDE group (18.8% (9/48) (P<0.05).

Conclusion

LBEPS for the treatment of calculi with the diameter of common bile duct ≥1.0 cm can promote the rapid recovery of patients after surgery, reduce the stress response of patients during surgery, and achieve a high success rate of stone extraction, as well as a low incidence of postoperative complications and high safety.

Key words: Choledocholithiasis, Laparoscopes, LCBDE, LBEPS, Comparative effectiveness research
表1 100例胆总管结石患者不同术式两组基线资料比较[(±s)，例]
组别 例 平均年龄(岁) 性别 结石类型
男/女 单发/多发
LCBDE组 52 40.5±1.5 26/26 31/21
LBEPS组 48 40.8±1.3 21/27 25/23
t/χ2值 ? 1.065 0.391 0.575
P值 ? 0.290 0.532 0.448
组别 例 总胆红素(mmol/L) 直接胆红素(mmol/L)
LCBDE组 52 50.1±5.2 35.4±2.4
LBEPS组 48 50.2±5.3 35.6±2.5
t/χ2值 ? 0.095 0.408
P值 ? 0.924 0.684
表2 100例胆总管结石患者不同术式两组患者临床指标比较[(±s), d]
组别 引流时间 下床活动时间 可进食时间 胃肠道功能恢复时间 住院时间
LCBDE组 4.3±0.4 3.5±0.6 1.6±0.1 0.7±0.1 7.7±0.6
LBEPS组 3.5±0.3 2.0±0.1 1.1±0.2 0.6±0.1 6.2±0.1
T 12.520 16.820 15.460 8.475 18.302
P 0.001 0.001 0.001 0.001 0.001
表3 100例胆总管结石患者不同术式两组患者术前、术后胆管压力、生活质量比较(±s)
组别 胆管压力(mmHg) 生活质量评分(分)
术前 术后 术前 术后
LCBDE组 12.4±1.6 11.7±0.7 76.6±6.5 105.2±9.6
LBEPS组 12.5±1.6 10.1±0.3 76.6±6.4 118.3±12.5
T 0.248 15.060 0.031 5.817
P 0.804 0.001 0.975 0.001
表4 100例胆总管结石患者不同术式两组患者手术前后机体应激反应比较(±s)
组别 时间 Cor(ng/ml) ACTH(ng/ml) NE(nmol/L)
LCBDE组 术前 102.2±8.1 12.7±1.5 2.9±0.2
? 术后 126.7±11.2 16.9±1.9 4.1±0.7
LBEPS组 术前 102.3±8.1 12.7±1.5 2.9±0.3
? 术后 113.3±6.6a 14.3±0.6a 3.3±0.1a
表5 100例胆总管结石患者不同术式两组患者取石成功率、结石残余率、复发率比较[例(%)]
组别 例 取石成功率 结石残余率 复发率
LCBDE组 48 46(95.8) 2(3.9) 4(8.3)
LBEPS组 52 50(96.2) 0(0.00) 2(3.9)
χ2 ? 0.007 2.211 0.891
P ? 0.935 0.137 0.345
表6 100例胆总管结石患者不同术式两组术后并发症发生情况比较(例)
组别 例 胆瘘 胆道出血 胆道狭窄 切口感染 总发生率(%)
LCBDE组 48 3 3 1 2 9(18.8)
LBEPS组 52 1 0 0 1 2(3.9)
χ2 ? ? ? ? ? 5.663
P ? ? ? ? ? 0.017
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