同步三镜联合胆管一期缝合技术在胆囊结石合并扩张性胆总管结石患者中的应用

  目的  探讨三镜联合技术在胆囊结石合并扩张性胆总管结石患者中的应用价值。  方法  回顾性分析昆明医科大学第二附属医院自2019年12月至2021年10月收治的胆囊结石合并扩张性胆总管结石（胆总管直径≥0.8cm）患者81例，按照手术方式不同分为:三镜组A组（n = 40），序贯行腹腔镜下胆囊切除术（LC）+腹腔镜-胆道镜联合探查取石术（LCBDE）+内镜下鼻胆管引流术（ENBD）+胆总管一期缝合术（PS）；双镜组B组（n = 41），序贯行LC+LCBDE+PS。观察指标包括术前指标（结石大小，胆总管直径），术中指标（出血量，手术时间）及术后指标（近远期并发症发生率，残石率）并进行统计学处理。  结果  B组胆管直径大于A组（P < 0.05），手术时间短于A组（P < 0.05）；术后残石率2组比较差异无统计学意义（P > 0.05），近期并发症方面，A组胆漏发生率较B组低（P < 0.05），远期并发症方面2组比较差异无统计学意义（P > 0.05）。  结论  三镜联合一期缝合技术在胆管扩张胆石症患者中的应用，能减轻胆管一期缝合技术中胆漏的发生率，减轻患者痛苦，提高患者依从性的同时并未增加并发症发生率及带管时间，值得临床推广使用。

Application of Syntaneous Trioscopy Combined with Bile Duct Suture Technique in Patients with Gallbladder Stones with Dilated Cholecholithiasis

  Objective  To explore the value of triple mirror combination technique in patients with dilated choledocholithiasis.   Methods  A retrospective analysis of 81 patients with dilated common bile duct stones （common bile duct diameter 0.8cm） were admitted to the Second Affiliated Hospital of Kunming Medical University from December 2019 to October 2021.Depending on the surgical method, patients were divided into three-mirror group group A （n = 40）, sequential laparoscopic cholecystectomy LC + laparoscopic-choledotoscopy combined exploration lithotomy LCBDE + endoscopic nasal bile duct drainage ENBD + primary common biliary suture PS.Double-mirror Group B （n = 41）, sequential rows of LC + LCBDE + PS. The observation indexes included preoperative indexes （stone size, total bile duct diameter）, intraoperative indexes （bleeding amount, operation time） and postoperative indexes （near-term complication rate, residual stone rate） and statistical treatment.   Results  Both groups of preoperative indicators, and the intraoperative indicators had no statistically significant differences. Operation time and bleeding volume were better in group B than in group A. Postoperative residual rate had no significant difference between the two groups. In terms of recent complications, the incidence of bile leakage in group A was lower than that in group B, and the long-term complications were relatively insignificant.   Conclusions  Application of triple oscopy combined primary suture in patients with cholangiogenic cholelithiasis can reduce the incidence of bile leakage in the first-phase bile duct suture technique, reduce the pain of patients, improve the patient compliance, and does not increase the incidence of complications and tube wearing time. It is worthy of clinical promotion and use.