[1]靳林上.腹腔镜下胆总管探查联合胆囊切除术治疗胆囊结石并发胆总管结石疗效观察[J].新乡医学院学报,2018,35(7):608-611.[doi:10.7683/xxyxyxb.2018.07.015]
　JIN Lin-shang.Effect of laparoscopic common bile duct exploration combined with cholecystectomy in the treatment of cholecystolithiasis complicated with choledocholithiasis[J].Journal of Xinxiang Medical University,2018,35(7):608-611.[doi:10.7683/xxyxyxb.2018.07.015]
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腹腔镜下胆总管探查联合胆囊切除术治疗胆囊结石并发胆总管结石疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年7
页码:
608-611
栏目:
临床研究
出版日期:
2018-07-05

文章信息/Info

Title:
Effect of laparoscopic common bile duct exploration combined with cholecystectomy in the treatment of cholecystolithiasis complicated with choledocholithiasis
作者:
靳林上
（焦作煤业集团有限责任公司中央医院普外科，河南　焦作　454000）
Author(s):
JIN Lin-shang
（Department of General Surgery，the Central Hospital of Jiaozuo Coal Industry Limited-Liability Company，Jiaozuo 454000，Henan Province，China）
关键词:
胆囊结石; 胆总管结石; 腹腔镜; 胆总管探查术; 胆囊切除术
Keywords:
cholecystolithiasis; choledocholithiasis; laparoscopy; common bile duct exploration; cholecystectomy
分类号:
R657.4+2
DOI:
10.7683/xxyxyxb.2018.07.015
文献标志码:
A
摘要:
目的　探讨腹腔镜下胆总管探查联合胆囊切除术治疗胆囊结石并发胆总管结石的临床效果。方法　选择2014年1月至2016年6月焦作煤业集团有限责任公司中央医院收治的胆囊结石并发胆总管结石患者96例，根据手术方法将患者分为观察组（44例）和对照组（52例）。对照组患者给予内镜十二指肠乳头括约肌切开术联合胆囊切除术治疗，观察组患者给予腹腔镜下胆总管探查联合胆囊切除术治疗；对2组患者的手术成功率、一期治愈率、结石残留率、手术情况、并发症发生率及结石复发率进行比较。结果　观察组患者手术成功率、一期治愈率、结石残留率分别为95.45%（42/44）、93.18%（41/44）、4.54%（3/44），对照组患者手术成功率、一期治愈率、结石残留率分别为92.30%（48/52）、76.92%（38/52）、21.15%（11/52）；观察组患者一期治愈率高于对照组（χ2=4.779，P<0.05），结石残留率低于对照组（χ2=3.932，P<0.05）；但2组患者手术成功率比较差异无统计学意义（χ2=0.403，P>0.05）。观察组患者手术时间、术后肛门排气时间、胃肠道功能恢复时间及住院时间显著短于对照组（P<0.05），术中出血量和住院费用显著少于对照组（P<0.05）。观察组和对照组患者并发症发生率分别为6.82%（3/44）、26.92%（14/52），观察组患者并发症发生率低于对照组（χ2=6.611，P<0.05）。观察组和对照组患者结石复发率分别为2.27%（1/44）、15.38%（8/52），观察组患者结石复发率低于对照组（χ2=4.823，P<0.05）。结论　腹腔镜下胆总管探查联合胆囊切除手术治疗胆囊结石并发胆总管结石的疗效显著，且具有手术时间短、创伤小、结石清除彻底、患者术后恢复快、并发症发生率和结石复发率低等优势。
Abstract:
Objective　To investigate the effect of laparoscopic common bile duct exploration combined with cholecystectomy in the treatment of cholecystolithiasis complicated with choledocholithiasis.Methods　A total of 96 patients with cholecystolithiasis and choledocholithiasis were selected from January 2014 to June 2016 in the Central Hospital of Jiaozuo Coal Industry Limited-Liability Company.The patients were divided into observation group （n=44） and control group （n=52） according to the operative method.The patients in the control group were treated with endoscopic sphincterotomy combined with cholecystectomy，and the patients in the observation group were treated with laparoscopic common bile duct exploration combined with cholecystectomy.The success rate of operation，primary healing rate，residual stone rate，operation condition，incidence of complications and stone recurrence rate were compared between the two groups.Results　The success rate of operation，primary healing rate and residual stone rate in the observation group was 95.45% （42/44），93.18% （41/44） and 4.54% （3/44） respectively；the success rate of operation，primary healing rate and residual stone rate in the control group was 92.30% （48/52），76.92% （38/52） and 21.15% （11/52） respectively.The primary healing rate in the observation group was higher than that in the control group （χ2=4.779，P<0.05），and the residual stone rate in the observation group was lower than that in the control group （χ2=3.932，P<0.05），but there was no significant difference in the success rate of operation between the two groups （χ2=0.403，P>0.05）.The operation time，postoperative anal exhaust time，gastrointestinal function recovery time and hospitalization time in the observation group were significantly shorter than those in the control group （P<0.05）.The intraoperative bleeding and hospitalization expenses in the observation group were significantly less than those in the control group （P<0.05）.The incidence of complications in the observation group and the control group was 6.82% （3/44） and 26.92% （14/52） respectively，the incidence of complications in the observation group was lower than that in the control group （χ2=6.611，P<0.05）.The stone recurrence rate in the observation group and the control group was 2.27% （1/44） and 15.38% （8/52） respectively，the stone recurrence rate in the observation group was lower than that in the control group （χ2=4.823，P<0.05）.Conclusion　Laparoscopic common bile duct exploration combined with cholecystectomy is effective in treating cholecystolithiasis complicated with choledocholithiasis.It has advantages of short operation time，small trauma，complete stone removal，rapid postoperative recovery，low incidence of complications and low stone recurrence rate.

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更新日期/Last Update: 2018-07-05