腹腔镜、胆道镜及十二指肠镜联合免T管引流对胆囊结石合并胆总管结石的治疗效果分析

目的探讨腹腔镜、胆道镜及十二指肠镜联合免T管引流对胆囊结石合并胆总管结石的治疗效果。方法选取2017年12月—2019年12月上海市健康医学院附属浦东新区人民医院普外科收治的胆囊结石合并胆管结石患者564例,根据手术方式分为腹腔镜经胆囊管胆道探查术(LTCBDE)组191例;三镜联合腹腔镜胆总管切开取石一期缝合术(LBEPS)组138例;十二指肠镜逆行胰胆管造影术(ERCP)+内镜乳头括约肌切开取石术(EST)/乳头柱状球囊扩张术(EPBD)+腹腔镜胆囊切除术(LC)组235例。统计3组患者性别、年龄、胆管直径、结石大小/数量等一般资料,比较手术及并发症情况。正态分布的计量资料组间比较采用单因素方差分析;非正态数据的计量资料组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ²检验。结果LTCBDE组、LBEPS组、ERCP+EST/EPBD+LC组3组间住院费用、引流量、排气时间、住院时间、引流管拔除时间,差异均有统计学意义(F值分别为416.40、7.799、33.99、143.70、13.08,P值分别为<0.001、0.020、<0.001、<0.001、<0.001),且LTCBDE组较其他2组住院费用更低、排气时间更早、住院时间更短、引流管拔除时间更短(P值均<0.05)。3组术后均未见严重并发症,并发症发生率差异无统计学意义(P>0.05)。所有患者术后均顺利出院。结论3种微创方式联合免T管引流治疗肝外胆管结石均达到了创伤小、痛苦小、术后恢复快、无严重并发症的目标,其中LTCBDE组治疗费用最低及术后恢复效果最佳。

Clinical effect of laparoscopy,choledochoscopy,and duodenoscopy combined with T-tube-free drainage in treatment of gallstones with common bile duct stones

Objective To investigate the clinical effect of laparoscopy,choledochoscopy,and duodenoscopy combined with T-tube-free drainage in the treatment of gallstones with common bile duct stones.Methods A retrospective analysis was performed for the clinical data of 564 patients with gallstones and common bile duct stones who were admitted to Department of General Surgery,Pudong New Area People’s Hospital,Shanghai University of Medicine&Health Sciences,from December 2017 to December 2019.According to the surgical procedure,the patients were divided into laparoscopic transcystic common bile duct exploration(LTCBDE)group with 191 patients,three endoscopies+laparoscopic common bile duct exploration and primary suture(LBEPS)group with 138 patients,and endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST)/endoscopic papillary balloon dilation(EPBD)+laparoscopic cholecystectomy(LC)group with 235 patients.The three groups were analyzed in terms of the general data including sex,age,bile duct diameter,and stone size/number,and surgical condition and complications were compared between groups.A one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.Results There were significant differences between the LBEPS group,the ERCP+EST/EPBD+LC group and the LTCBDE group in hospital costs,drainage volume,time to first flatus,length of hospital stay and time to extraction of drainage tube(F=416.40,7.80,33.99,143.70,and 13.08,P<0.001,P=0.020,P<0.001,P<0.001,and P<0.001).Compared with the LBEPS group and ERCP+EST/EPBD+LC groups,the LTCBDE group had significantly lower hospital costs and a significantly longer time to first flatus,and significantly shorter length of hospital stay and time to extraction of drainage tube(all P<0.05).No serious complication was observed after surgery,and there was no significant difference in the incidence rate of complications between the three groups(P>0.05).All patients were discharged successfully after surgery.Conclusion The three minimally invasive surgical procedures combined with T-tube-free drainage achieve the goal of little trauma and pain,fast postoperative recovery,and few serious complications,among which LTCBDE has the lowest treatment costs and the best postoperative recovery.