腹腔镜与胆道镜联合同期治疗胆囊结石合并胆总管结石38例
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摘要
目的探讨胆囊结石合并胆总管结石采取腹腔镜与胆道镜联合(双镜联合)治疗的临床疗效。方法纳入新沂市人民医院2013年6月至2016年6月确诊为胆囊结石合并胆总管结石的病人76例,其中采用双镜联合治疗组38例,行开放手术治疗组38例,收集并比较两组病人术前、术中及术后的资料,并对纳入研究病例进行3个月至3年随访。观察两组术中出血量、手术时间、术后下床活动时间、术后排气时间、疼痛视觉模拟评分(VAS评分)、术后并发症、术后结石残留、胆管炎复发、结石复发等指标以评价治疗效果。结果双镜联合治疗组术中出血量(69±35) mL、术后排气时间(32±12) h、术后下床活动时间(1.4±0.3) d、VAS评分(3.2±1.1)、住院时间(14.5±3.6) d、术后并发症发生率(7.9%),与开放手术治疗组的(175±65) mL、(85±21) h、(3.5±1.1) d、(6.8±2.0)、(18.2±5.6) d、(26.3%)比较,差异有统计学意义(P<0.05)。术后4周行经T管胆道造影发现开放手术治疗组结石残留3例,双镜联合治疗组无残留。术后随访3月至3年,开放手术治疗组3例胆总管结石复发,双镜联合治疗组无结石复发。开放手术治疗组3例发生胆管炎,双镜联合治疗组无胆管炎发生。结论腹腔镜与胆道镜联合治疗胆囊结石合并胆总管结石与传统开放手术相比,具有恢复快、创伤小、并发症少、住院时间短等优点,安全有效。
Objective To investigate the clinical efficacy of the combination of laparoscopic and choledochoscopic technique(combination of scopes) in the treatment of biliary gallbladder stones combined with common bile duct stones.Methods Seventy-six patients diagnosed with gallbladder and common bile duct stones in Xinyi People's Hospital from June 2013 to June 2016 were enrolled in this study,38 patients treated with laparoscopic and choledochoscopic technique,38 patients treated with open surgery.Preoperative,intraoperative and postoperative data were collected and compared between 2 groups,and all the patients were followed up for 3 months to 3 years.The operative time,blood loss,postoperative exhaust time and postoperative ambulation time,VAS scores,postoperative complications,postoperative residual stones,stone recurrence,recurrent cholangitis and other indicators were collected and analysised.Results In double endoscopic group,blood loss(69±35) mL,postoperative discharge time(32±12) h,postoperative ambulation time(1.4±0.3) d,VAS score(3.2±1.1),hospital stay days(14.5±3.6) d,incidence of postoperative complications(7.9%),compared with that in open group is(175±65) mL,(85±21) h,(3.5±1.1) d,VAS score(6.8±2.0),(18.2±5.6) d and(26.3%) respectively,the difference was statistically significant(P<0.05).Residual stones were found in 3 patients of the open group through the T-tube cholangiography 4 weeks after operation,and there is no stone residue in laparoscopic group.After followed up for 3 months to 3 years,bile duct stone recurrence were found 3 patients in open surgery group,and there is no stone recurrence in laparoscopic group; and there is 3 patiens with cholangitis recurrent in open operation group,of the patiens in laparoscopic group had no recurrence.Conclusion Compared with traditional open surgery,laparoscopic and endoscopic treatment biliary gallstone biliary calculi has many advantage,such as less trauma,quicker recovery,fewer complications,shorter hospital stay,safe and effective.
Objective To investigate the clinical efficacy of the combination of laparoscopic and choledochoscopic technique(combination of scopes) in the treatment of biliary gallbladder stones combined with common bile duct stones.Methods Seventy-six patients diagnosed with gallbladder and common bile duct stones in Xinyi People's Hospital from June 2013 to June 2016 were enrolled in this study,38 patients treated with laparoscopic and choledochoscopic technique,38 patients treated with open surgery.Preoperative,intraoperative and postoperative data were collected and compared between 2 groups,and all the patients were followed up for 3 months to 3 years.The operative time,blood loss,postoperative exhaust time and postoperative ambulation time,VAS scores,postoperative complications,postoperative residual stones,stone recurrence,recurrent cholangitis and other indicators were collected and analysised.Results In double endoscopic group,blood loss(69±35) mL,postoperative discharge time(32±12) h,postoperative ambulation time(1.4±0.3) d,VAS score(3.2±1.1),hospital stay days(14.5±3.6) d,incidence of postoperative complications(7.9%),compared with that in open group is(175±65) mL,(85±21) h,(3.5±1.1) d,VAS score(6.8±2.0),(18.2±5.6) d and(26.3%) respectively,the difference was statistically significant(P<0.05).Residual stones were found in 3 patients of the open group through the T-tube cholangiography 4 weeks after operation,and there is no stone residue in laparoscopic group.After followed up for 3 months to 3 years,bile duct stone recurrence were found 3 patients in open surgery group,and there is no stone recurrence in laparoscopic group; and there is 3 patiens with cholangitis recurrent in open operation group,of the patiens in laparoscopic group had no recurrence.Conclusion Compared with traditional open surgery,laparoscopic and endoscopic treatment biliary gallstone biliary calculi has many advantage,such as less trauma,quicker recovery,fewer complications,shorter hospital stay,safe and effective.
引文
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[9] 于江涛,黄强,王军.腹腔镜胆道探查术与传统开腹手术治疗胆囊结石合并胆总管结石的临床价值比较[J].安徽医科大学学报,2012,47(5):615-616,封3.
[10] 赵海峰,于大海,佟立权,等.腹腔镜和内镜联合治疗胆囊结石和胆管结石[J].中国普通外科杂志,2008,17(8):820-821.
[11] TAN KK,SHELAT VG,LIAU KH,et al.Laparoscopic common bile duct exploration:our first 50 cases[J].Ann Acad Med Singapore,2010,39(2):136-142.
[12] 邹浩,朱红,张小文,等.胆囊结石合并胆总管结石微创治疗方式的选择[J].广东医学,2011,32(10):1319-1321.
[13] RESHETNYAK VI.Concept of the pathogenesis and treatment of cholelithiasis[J].World J Hepatol,2012,4(2):18-34.
[14] 朱兴国,王恒建,王成宏.术中经胆囊管胆道造影在腹腔镜胆囊切除术中的应用[J].安徽医药,2015,19(3):532-533.
[15] BENCINI L,TOMMASI C,MANETTI R,et al.Modern approach to cholecysto-choledocholithiasis[J].World J Gastrointest Endosc,2014,6(2):32-40.
[16] LEE HM,MIN SK,LEE HK.Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single cente[J].Ann Surg Treat Res,2014,86(1):1-6.
[2] VAN DIJK AH,LAMBERTS M,VAN LAARHOVEN CJ,et al.Laparoscopy in cholecysto-choledocholithiasis[J].Best Pract Res Clin Gastroenterol,2014,28(1):195-209.
[3] 林美举,杨玉龙,张洪威,等.胆囊结石合并胆总管结石微创治疗的探讨[J].中国内镜杂志,2011,17(7):775-778.
[4] 杨红旗,方道连,马祖胜,等.十二指肠镜联合腹腔镜与单独腹腔镜治疗胆囊结石合并胆总管结石的对比观察[J].中华消化内镜杂志,2009,26(8):432-433.
[5] 石景森,王炳煌.胆道外科基础与临床[M].北京:人民卫生出版社,2003:208-210.
[6] SANTO MA,DOMENE CE,RICCIOPPO D,et al.Common bile duct stones:analysis of the videolaparoscopic surgical treatment[J].Arq Gastroenterol,2012,49(1):41-51.
[7] 尹卫民,孙喜太,周建新.腹腔镜联合EST序贯治疗胆囊结石合并胆总管结石125例临床分析[J].南京医科大学学报:自然科学版,2010,30(9):1321-1323.
[8] 常亚东,杨闯,古广强,等.腹腔镜手术中对胆囊颈管结石的诊断及处理[J].中国普通外科杂志,2009,18(2):124-126.
[9] 于江涛,黄强,王军.腹腔镜胆道探查术与传统开腹手术治疗胆囊结石合并胆总管结石的临床价值比较[J].安徽医科大学学报,2012,47(5):615-616,封3.
[10] 赵海峰,于大海,佟立权,等.腹腔镜和内镜联合治疗胆囊结石和胆管结石[J].中国普通外科杂志,2008,17(8):820-821.
[11] TAN KK,SHELAT VG,LIAU KH,et al.Laparoscopic common bile duct exploration:our first 50 cases[J].Ann Acad Med Singapore,2010,39(2):136-142.
[12] 邹浩,朱红,张小文,等.胆囊结石合并胆总管结石微创治疗方式的选择[J].广东医学,2011,32(10):1319-1321.
[13] RESHETNYAK VI.Concept of the pathogenesis and treatment of cholelithiasis[J].World J Hepatol,2012,4(2):18-34.
[14] 朱兴国,王恒建,王成宏.术中经胆囊管胆道造影在腹腔镜胆囊切除术中的应用[J].安徽医药,2015,19(3):532-533.
[15] BENCINI L,TOMMASI C,MANETTI R,et al.Modern approach to cholecysto-choledocholithiasis[J].World J Gastrointest Endosc,2014,6(2):32-40.
[16] LEE HM,MIN SK,LEE HK.Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis:15-year experience from a single cente[J].Ann Surg Treat Res,2014,86(1):1-6.