【摘要】 目的 探讨腹腔镜下胆道镜联合术中胆道造影经胆囊管治疗胆囊结石合并胆总管结石的临床应用价值。方法 收集2020年10月至2023年3月湖州市中心医院肝胆胰外科胆囊结石合并胆总管结石行微创治疗113例患者的临床资料,其中腹腔镜下胆道镜联合术中胆道造影经胆囊管行胆总管探查取石术(LTCCBDE组)32例,腹腔镜下经胆总管切开路径探查取石+T管引流术(LTDCBDE组)39例,腹腔镜胆囊切除联合经内镜逆行胰胆管造影+乳头切开取石术(LC+ERCP+EST组)42例,比较3组患者术前及术后ALT、TBil、DBil、IBil、WBC、CRP水平,术后血清淀粉酶(AMY)、手术时间、术中出血量、术后胆瘘发生率、术后住院时间、住院费用及术后6周胃肠疾病生命质量指数(GIQLI)评分的差异。结果 LTCCBDE组手术成功32例,术中转行LTDCBDE 4例,LTDCBDE组及LC+ERCP+EST组均手术成功。LTCCBDE组术前WBC、ALT、TBil、IBil及术后CRP、ALT水平与LTDCBDE组比较差异均有统计学意义(均P<0.05),术前WBC及术后ALT与LC+ERCP+EST组比较差异均有统计学意义(均P<0.05)。LTCCBDE组手术时间低于LTDCBDE组及LC+ERCP+EST组(均P<0.05),术中出血量及术后住院时间均低于LTDCBDE组(均P<0.05),与LC+ERCP+EST组比较差异均无统计学意义(均P>0.05)。LTCCBDE组住院费用及术后6周GIQLI评分与LTDCBDE组及LC+ERCP+EST组比较差异均有统计学意义(均P<0.001)。结论 腹腔镜下胆道镜联合术中胆道造影经胆囊管治疗胆囊结石合并胆总管结石有较好疗效,可加快患者术后康复及改善生活质量,符合加速康复外科理念,值得临床推广应用。更多还原

【Abstract】 Objective To explore the clinical application of laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography in treatment of patients with cholecystocholedocholithiasis.Methods Clinical data of 113 patients with cholecystocholedocholithiasis admitted in Huzhou Central Hospital from October 2020 to March 2023 were enrolled, including 32 cases treated by laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography( LTCCBDE group), 39 cases treated by laparoscopic trans-duct common bile duct exploration plus T-tube drain(LTDCBDE group), and 42 cases treated by laparoscopic cholecystectomy+ endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy(LC+ERCP+EST group). The preoperative and postoperative ALT, TBil, DBil, iIBil, WBC, CRP, postoperative amylase(AMY), operative time and intraoperative bleeding, postoperative biliary fistula rate, postoperative hospital stay, hospitalization cost and the perioperative gastrointestinal quality of life index(GIQLI) at 6th week were compared among three groups. Results Among 36 cases scheduled to receive LTCCBDE, 4 cases failed and transferred to LTDCBDE. Thirty-nine cases in LTDCBDE group and 42 cases in LC+ERCP+EST group were treated successfully. There were significant differences in preoperative WBC, ALT, TBil,IBil and postoperative CRP and ALT between LTCCBDE and LTDCBDE groups(all P<0.05). There were significantly different in preoperative WBC and postoperative ALT between LTCCBDE and LC+ERCP+EST groups(both P<0.05). The operative time in LTCCBDE group was significantly lower than those in LTDCBDE and LC+ERCP+EST groups(both P<0.05).The intraoperative bleeding and postoperative hospital stay in LTCCBDE group were significantly lower than those in LTDCBDE group(both P < 0.05) and there were no significant differences between LTCCBDE and LC + ERCP + EST groups(both P > 0.05). There were statistically significant in hospitalization costs and postoperative GIQLI scores at 6th week in LTCCBDE group compared to LTDCBDE and LC + ERCP + EST groups respectively(all P<0.001). Conclusion Laparoscopic trans-cystic common bile duct exploration combined with choledochofiberscopy and cholangiography is effective in treatment of patients with cholecystocholedocholithiasis. It can accelerate postoperative rehabilitation and improve the quality of life in consistent with the concept of enhanced recovery after surgery(ERAS), therefore, it merits clinical application.更多还原