腹腔镜联合胆道镜双镜治疗胆囊结石合并胆总管结石价值分析
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摘要
目的探讨腹腔镜联合胆道镜双镜治疗胆囊结石合并胆总管结石的临床价值。方法选择2017年2月～2018年7月本院收治的胆囊结石合并胆总管结石患者80例,按照随机数字表法分为两组,均为40例。所有患者均在全身麻醉气管插管下实施手术治疗,手术方法上,观察组行腹腔镜联合胆道镜进行,对照组行开腹胆囊切除联合胆道探查及T管引流。比较两组手术相关数据,如手术时间、术中出血及术后肛门排气时间,统计两组围术期并发症,如胆漏、胆道出血、严重疼痛及切口感染等并发症的整体发生率,比较两组手术前后肝功能相关指标,如谷丙转氨酶、直接胆红素及间接胆红素水平变化情况。结果观察组手术时间短于对照组(P <0.05),术中出血少于对照组(P <0.05),术后肛门排气时间早于对照组(P <0.05),观察组发生胆漏、胆道出血、严重疼痛及切口感染等并发症的整体发生率低于对照组(P <0.05),干预后观察组谷丙转氨酶、直接胆红素及间接胆红素水平低于对照组(P <0.05)。结论针对胆囊结石合并胆总管结石者,使用腹腔镜联合胆道镜治疗,其手术创伤小,术后恢复快,并发症少,更利于患者术后肝功能恢复,从而显著提高临床治疗效率。
Objective To analyze the clinic value of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis with choledocholithiasis. Methods Eighty patients with cholecystolithiasis complicated with choledocholithiasis who admitted to our hospital during February 2017 to July 2018 were collected and divided into an observation group and a control group,with 40 cases in each group.All patients were treated with endotracheal intubation under general anesthesia.The observation group was treated with laparoscope combined with choledochoscope,while the control group was treated with open cholecystectomy combined with bile duct exploration and T tube drainage.The operative time,intraoperative bleeding and postoperative anal exhaust time were compared between the two groups.The overall incidence of perioperative complications such as biliary leakage,biliary tract bleeding,severe pain and incision infection were calculated.The liver function of the two groups before and after surgery were compared,such as alanine aminotransferase,direct bilirubin and indirect bilirubin. Results The operation time of the observation group was shorter than that of the control group(P < 0.05),the intraoperative bleeding was less than that of the control group(P < 0.05),and the postoperative anal exhaust time was earlier than that of the control group(P < 0.05).The overall incidence of biliary leakage,biliary tract bleeding,severe pain and incision infection in the observation group were lower than that in the control group(P < 0.05).After intervention,the levels of alanine aminotransferase,direct and indirect bilirubin in the observation group were lower than those in the control group(P < 0.05). Conclusion For patients with cholecystolithiasis complicated with choledocholithiasis,laparoscopy combined with choledochoscope is used for treatment,which results in less surgical trauma,faster postoperative recovery and fewer complications,and is more conducive to the recovery of postoperative liver function,can significantly improve the clinical treatment efficiency.
Objective To analyze the clinic value of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis with choledocholithiasis. Methods Eighty patients with cholecystolithiasis complicated with choledocholithiasis who admitted to our hospital during February 2017 to July 2018 were collected and divided into an observation group and a control group,with 40 cases in each group.All patients were treated with endotracheal intubation under general anesthesia.The observation group was treated with laparoscope combined with choledochoscope,while the control group was treated with open cholecystectomy combined with bile duct exploration and T tube drainage.The operative time,intraoperative bleeding and postoperative anal exhaust time were compared between the two groups.The overall incidence of perioperative complications such as biliary leakage,biliary tract bleeding,severe pain and incision infection were calculated.The liver function of the two groups before and after surgery were compared,such as alanine aminotransferase,direct bilirubin and indirect bilirubin. Results The operation time of the observation group was shorter than that of the control group(P < 0.05),the intraoperative bleeding was less than that of the control group(P < 0.05),and the postoperative anal exhaust time was earlier than that of the control group(P < 0.05).The overall incidence of biliary leakage,biliary tract bleeding,severe pain and incision infection in the observation group were lower than that in the control group(P < 0.05).After intervention,the levels of alanine aminotransferase,direct and indirect bilirubin in the observation group were lower than those in the control group(P < 0.05). Conclusion For patients with cholecystolithiasis complicated with choledocholithiasis,laparoscopy combined with choledochoscope is used for treatment,which results in less surgical trauma,faster postoperative recovery and fewer complications,and is more conducive to the recovery of postoperative liver function,can significantly improve the clinical treatment efficiency.
引文
[1]李越华,魏东,王琨,等.腹腔镜与开腹左肝外叶切除联合胆道镜取石治疗左肝内胆管结石的疗效比较[J].中国普通外科杂志,2015,24(8):1070-1076.
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[3]赵冬雨,成丽娅,沈宏,等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用研究[J].中国普外基础与临床杂志,2013,20(7):793-796.
[4]钟伟,倪谢根.腹腔镜联合纤维胆道镜与开腹手术治疗老年胆总管结石对术后疼痛及胃肠功能的影响[J].中国普通外科杂志,2015,24(2):280-283.
[5]王亮,杨伟,曹文锋,等.后腹腔镜联合胆道镜治疗嵌顿性输尿管上段结石及肾结石的临床应用[J].中国内镜杂志,2015,21(2):196-198.
[6]陈永军,蔡小勇,卢榜裕,等.腹腔镜左肝切除联合胆道镜治疗肝内胆管结石的效果[J].广东医学,2014,35(2):241-243.
[7]王亮,杨伟,曹文锋,等.后腹腔镜联合胆道镜治疗嵌顿性输尿管上段结石及肾结石的临床应用[J].中国内镜杂志,2015,21(2):196-198.
[8]陈永标,池小斌,江艺,等.腹腔镜肝切除联合胆道镜治疗肝内外胆管结石36例[J].中国微创外科杂志,2016,16(9):777-779.
[9]李帅,张东,侯元凯,等.腹腔镜联合胆道镜微创保胆取石术后胆囊结石复发相关因素分析[J].腹腔镜外科杂志,2015,20(7):535-538.
[10]王亮,折占飞,乔宇,等.腹腔镜联合胆道镜经胆囊管探查治疗胆囊结石合并胆总管结石[J].中国微创外科杂志,2017,17(2):189-192.
[11]曹云,赵国刚,田君,等.腹腔镜联合胆道镜治疗胆总管结石合并胆囊结石的临床研究[J/OL].川北医学院学报,2018,11(4):548-550
[12]张斌,曹宽,温泉,等.腹腔镜下胆道镜和液电碎石机治疗继发性肝内外胆管嵌顿难取性结石[J].局解手术学杂志,2018,27(3):187-191.
[13]陈武.腹腔镜联合胆道镜治疗胆囊结石并胆总管结石的临床疗效[J].安徽医药,2018,22(4):629-631.
[14]陈铁炯,郑军.腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石临床对比分析[J].中华全科医学,2018,16(2):226-228.
[15]杨彦,林师佈,韩霖,等.腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析[J].临床肝胆病杂志,2018,34(3):526-530.
[16]菅志远,沈先锋,黄林生,等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析[J].中国普通外科杂志,2015,24(2):275-279.
[17]王贺洪.胆道镜联合腹腔镜液电碎石治疗复杂胆外胆管结石20例临床分析[J].航空航天医学杂志,2018,29(6):690-692.
[18]赵业民,陈增银,王杰.腹腔镜联合胆道镜技术治疗复发性肝胆管结石的临床观察[J].泰山医学院学报,2018,39(2):169-171.
[2]彭颖,王立新,徐智,等.腹腔镜联合胆道镜经胆囊管汇入部微切开治疗胆囊结石合并胆总管结石[J].中国微创外科杂志,2015,15(3):224-227.
[3]赵冬雨,成丽娅,沈宏,等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用研究[J].中国普外基础与临床杂志,2013,20(7):793-796.
[4]钟伟,倪谢根.腹腔镜联合纤维胆道镜与开腹手术治疗老年胆总管结石对术后疼痛及胃肠功能的影响[J].中国普通外科杂志,2015,24(2):280-283.
[5]王亮,杨伟,曹文锋,等.后腹腔镜联合胆道镜治疗嵌顿性输尿管上段结石及肾结石的临床应用[J].中国内镜杂志,2015,21(2):196-198.
[6]陈永军,蔡小勇,卢榜裕,等.腹腔镜左肝切除联合胆道镜治疗肝内胆管结石的效果[J].广东医学,2014,35(2):241-243.
[7]王亮,杨伟,曹文锋,等.后腹腔镜联合胆道镜治疗嵌顿性输尿管上段结石及肾结石的临床应用[J].中国内镜杂志,2015,21(2):196-198.
[8]陈永标,池小斌,江艺,等.腹腔镜肝切除联合胆道镜治疗肝内外胆管结石36例[J].中国微创外科杂志,2016,16(9):777-779.
[9]李帅,张东,侯元凯,等.腹腔镜联合胆道镜微创保胆取石术后胆囊结石复发相关因素分析[J].腹腔镜外科杂志,2015,20(7):535-538.
[10]王亮,折占飞,乔宇,等.腹腔镜联合胆道镜经胆囊管探查治疗胆囊结石合并胆总管结石[J].中国微创外科杂志,2017,17(2):189-192.
[11]曹云,赵国刚,田君,等.腹腔镜联合胆道镜治疗胆总管结石合并胆囊结石的临床研究[J/OL].川北医学院学报,2018,11(4):548-550
[12]张斌,曹宽,温泉,等.腹腔镜下胆道镜和液电碎石机治疗继发性肝内外胆管嵌顿难取性结石[J].局解手术学杂志,2018,27(3):187-191.
[13]陈武.腹腔镜联合胆道镜治疗胆囊结石并胆总管结石的临床疗效[J].安徽医药,2018,22(4):629-631.
[14]陈铁炯,郑军.腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石临床对比分析[J].中华全科医学,2018,16(2):226-228.
[15]杨彦,林师佈,韩霖,等.腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析[J].临床肝胆病杂志,2018,34(3):526-530.
[16]菅志远,沈先锋,黄林生,等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析[J].中国普通外科杂志,2015,24(2):275-279.
[17]王贺洪.胆道镜联合腹腔镜液电碎石治疗复杂胆外胆管结石20例临床分析[J].航空航天医学杂志,2018,29(6):690-692.
[18]赵业民,陈增银,王杰.腹腔镜联合胆道镜技术治疗复发性肝胆管结石的临床观察[J].泰山医学院学报,2018,39(2):169-171.