腹腔镜、胆道镜、胃镜三镜联合治疗胆囊结石伴胆总管结石的疗效分析

目的：探讨腹腔镜、胆道镜和胃镜三镜联合在治疗胆囊结石伴胆总管结石中的临床价值。方法：回顾性分析2019年1月—2021年12月在天津市第五中心医院普外科进行治疗的137例胆囊结石合并胆总管结石患者的临床资料。根据患者采取的手术方式，将研究对象分为三组：观察组、对照1组、对照2组。观察组采取腹腔镜、胆道镜、胃镜联合行胆囊切除、胆道探查取石+BD管引流+胆管一期缝合的治疗方式；对照1组采取腹腔镜下胆囊切除+胆总管切开胆道镜探查取石+T管引流的治疗方式；对照2组采取经内镜逆行性胰胆管造影术胆道取石+腹腔镜胆囊切除术；比较三组的相关临床指标。结果：三组在手术时间、术中出血量、术后腹引管拔管时间方面无统计学差异(P>0.05)，观察组住院时间、住院费用均低于对照组，差异有统计学意义(P <0.05)。三组单次结石取尽率差异无统计学意义。观察组腹腔感染、出血、胆漏、窦道断裂等并发症少于对照组，有统计学差异(P <0.05)。结论：对于胆囊结石合并胆总管结石患者，通过腹腔镜、胆道镜、胃镜三镜联合行胆囊切除+胆管探查取石+BD管引流+胆管一期缝合，能明显提高治疗效果，患者痛苦小，术后...

Efficacy analysis of laparoscopy, choledochoscopy and gastroscopy in the treatment of gallstones with common bile duct stones

Objective To explore the clinical application value of laparoscopy, choledochoscopy and gastroscopy in the treatment of gallstones with choledocholithiasis. Methods The clinical data of 137 patients with cholecystolithiasis combined with choledocholithiasis who were treated in the general surgery department of Tianjin Fifth Central Hospital from January 2019 to December 2021 were retrospectively analyzed. According to the surgical methods, the patients were divided into three groups: observation group, control group 1 and control group 2. The observation group was treated with laparoscopic cholecystectomy, choledochoscopy and gastroscope combined with cholecystectomy, bile duct exploration and stone extraction + BD tube drainage + primary suture of bile duct, while the control group 1 was treated with laparoscopic cholecystectomy + choledochoscopy exploration and stone extraction+T tube drainage; The ERCP bile duct stone extraction + LC cholecystectomy were performed in control group 2. Three groups of relevant clinical indicators were analyzed statistically. Results There was no statistical differences in operation time, intraoperative blood loss and the postoperative abdominal catheterization time among the three groups (P> 0.05). The T-tube, hospitalization time and hospitalization cost were better than those in the control group (P<0.05). The complications such as abdominal infection, hemorrhage, biliary fistula and sinus rupture in the observation group were less than those in the control group, with statistical difference (P<0.05). Conclusion For gallstones with choledochal stone patients, through the treatment of laparoscopy, choledochoscope, gastroscope combined cholecystectomy + bile duct exploration stone + BD tube drainage + bile duct primary suture can significantly improve the therapeutic effect, patient pain, low postoperative complications, also can effectively reduce the hospital time and hospitalization costs, which has a good clinical application value.