目的 探讨三种微创手术治疗胆总管结石合并胆囊结石的效果。方法 回顾性分析2018-01至2021-09武警安徽总队医院收治的85例胆总管结石合并胆囊结石患者的临床资料,依据不同手术方法分为A、B、C三组:A组30例采用腹腔镜胆总管探查(LCBDE)+T管引流(TD)+腹腔镜胆囊切除术(LC),B组30例采用内镜逆行胰胆管造影结合内镜乳头括约肌切开(ERCP/EST)+腹腔镜胆囊切除术,C组25例采用腹腔镜胆总管探查+一期缝合(PS)+腹腔镜胆囊切除术组,比较分析三组患者的住院时间、住院费用、术前肝功能、手术相关情况、术后恢复情况和术后并发症之间的差别。结果 三组术前丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、直接胆红素(DBIL)、术后胆管炎、胆汁漏、出血、结石残留和总体并发症发生率比较差异无统计学意义;A组住院时间(14.13±2.50)d、术中出血(18.50±7.45) ml、术后6、12、24 h疼痛评分明显高于B、C两组,生活质量评分(67.03±5.54)和腹壁美观满意度评分(2.50±0.73)均明显低于B、C两组,差异均有统计学意义(P<0.05)。B组术后48 h疼痛评分为(0.37±0.77)分、肛门通气时间(18.33±5.16) h,下床活动时间(9.30±6.53) h明显优于A、C两组,差异有统计学意义(P<0.05);但住院费用(27 499±4577)元、术后胰腺炎发生率(13.33%)显著高于A、C两组。C组手术时间为(89.20±37.38)min,明显长于A、B两组,差异有统计学意义(P<0.05)。结论 三种手术方式治疗胆总管结石合并胆囊结石均安全有效,对于要求术后快速康复、腹壁美观及生活质量高且符合PS手术适应证的患者,建议采用LCBDE+PS+LC术。

Objective To explore the effect of three kinds of minimally invasive surgical methods for choledocholithiasis with cholecystolithiasis.Methods The clinical data of 85 patients with choledocholithiasis and cholecystolithiasis admitted to Provincial Corps Hospital of Chinese People's Armed Police Force from January 2018 to September 2021 were retrospectively analyzed. According to different surgical methods, they were divided into three groups,30 cases in group A were treated with laparoscopic common bile duct exploration (LCBDE)+T-tube drainage (TD)+laparoscopic cholecystectomy (LC), 30 cases in group B were treated with endoscopicretrograde cholangiopancreatography combined with endoscopic papillary Sphincter incision (ERCP/EST)+laparoscopic cholecystectomy, and 25 cases in group C were treated with laparoscopic common bile duct exploration+primary suture (PS)+laparoscopic cholecystectomy The differences of hospitalization time, hospitalization expenses, preoperative liver function, surgical related conditions, postoperative recovery, and postoperative complications among the three groups of patients were compared and analyzed.Results There was no significant difference in the incidence of preoperative alanine aminotransferase (ALT), aspartate transaminase (AST), direct bilirubin (DBIL), postoperative cholangitis, bile leakage, bleeding, stone residue or overall complications among the three groups. The hospitalization time (14.13±2.50) days, intraoperative bleeding (18.50±7.45) ml, postoperative pain scores at 6, 12, and 24 hours in Group A were significantly higher than those in Group B and Group C. The quality of life scores (67.03±5.54) and abdominal wall aesthetic satisfaction scores (2.50±0.73) were significantly lower than those in Group B and Group C. The differences were statistically significant (P<0.05). The pain scores of Group B at 48 hours after surgery was (0.37±0.77) points, the anal ventilation time was (18.33±5.16) hours, and the time to get out of bed was (9.30±6.53) hours, which were significantly better than those of Group A and Group C (P<0.05). However, the hospitalization cost (27 499±4577) yuan and the incidence of postoperative pancreatitis (13.33%) were significantly higher than those of groups A and C. The surgical time in Group C was (89.20±37.38) minutes, significantly longer than that in Groups A and B, with a statistically significant difference (P<0.05).Conclusions Three surgical methods are safe and effective for the treatment of common bile duct stones combined with gallbladder stones. For patients who require rapid postoperative recovery, beautiful abdominal wall and high quality of life, and meet the indications for PS surgery, it is recommended to use LCBDE+PS+LC surgery.