腹腔镜联合胆道镜下胆总管探查术治疗胆总管结石的临床疗效

Clinical efficacy of laparoscopy combined with choledochoscopy for exploration common bile duct in treatment of calculus of common bile duct

摘要:

目的 探讨腹腔镜联合胆道镜下胆总管探查术治疗胆总管结石的临床疗效。方法 回顾性分析2022年1月－2024年4月该院收治的102例胆总管结石患者的临床资料，按不同术式将患者分为腔镜组（n = 52，行腹腔镜联合胆道镜下胆总管探查术）和开腹组（n = 50，行开腹手术）。比较两组患者围术期指标、胃泌素族激素水平（血清胃泌素和胆囊收缩素）、肝功能（血清总胆红素和总胆汁酸）和术后并发症情况。结果 两组患者手术时间和结石清除率比较，差异均无统计学意义（P > 0.05），腔镜组术中出血量明显少于开腹组，首次排气时间和术后住院时间明显短于开腹组，差异均有统计学意义（P < 0.05）；术后3 d，两组患者血清胃泌素水平明显低于术前1 d，血清胆囊收缩素水平明显高于术前1 d，差异均有统计学意义（P < 0.05）；术后3 d，腔镜组血清胃泌素水平明显高于开腹组，血清胆囊收缩素水平明显低于开腹组，差异均有统计学意义（P < 0.05）；术后3 d，两组患者血清总胆红素和总胆汁酸水平明显低于术前1 d，且腔镜组明显低于开腹组，差异均有统计学意义（P < 0.05）；腔镜组并发症发生率为7.69%，明显低于开腹组的26.00%，差异有统计学意义（P < 0.05）。结论 腹腔镜联合胆道镜下胆总管探查术治疗胆总管结石，结石清除率与开腹手术相当，但该术式有助于肝功能的快速恢复，对胃泌素族激素的影响小，还能降低并发症的发生风险，加快术后康复进程。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of laparoscopy combined with choledochoscopy for exploration common bile duct in treatment of calculus of common bile duct.Methods A retrospective analysis was conducted on clinical data of 102 patients with calculus of common bile duct from January 2022 to April 2024. They were separated into laparoscopic group (n = 52, who underwent laparoscopy combined with choledochoscopy for exploration common bile duct) and open group (n = 50, who underwent open surgery) according to the different surgical methods used. Perioperative indicators, serum gastrin hormone levels [gastrin and cholecystokinin], liver function [serum total bilirubin and serum total bile acid], and postoperative complications were compared between the two groups.Results There were no statistically significant differences in surgical time and stone clearance rate between the laparoscopic group and the open group (P > 0.05), while intraoperative blood loss in laparoscopic group was less than that in open group, the first exhaust time and postoperative hospital stay in the laparoscopic group were shorter than those in open group, the differences were statistically significnat (P < 0.05); On the third day after surgery, the serum gastrin levels in both groups were lower than those on the first day before surgery, and the serum cholecystokinin levels were higher than those on the first day before surgery, the differences were statistically significant (P < 0.05); On the third day after surgery, the serum gastrin level in the laparoscopic group was higher than that in open group, and the serum cholecystokinin level was lower than that in open group, the differences were statistically significant (P < 0.05); Three days after surgery, the levels of serum total bilirubin and serum total bile acid in both groups were lower than those 1 day before surgery, and both indicators in laparoscopic group were lower than those in open group, the differences were statistically significant (P < 0.05); The incidence of complications in laparoscopic group was 7.69%, lower than that in open group was 26.00%, , the difference was statistically significant (P < 0.05).Conclusion The stone removal effect of laparoscopy combined with choledochoscopy for exploration common bile duct in patients with calculus of common bile duct is comparable to that of open surgery. However, compared with open surgery, this study's surgical procedure is more conducive to the rapid recovery of liver function, reduce the impact on gastrin hormones and the risk of complications, and accelerate the postoperative recovery process. It is worthy of clinical application.