三种术式治疗再发性胆总管结石的疗效及安全性比较

目的比较腹腔镜结合内镜、腹腔镜结合十二指肠镜和开腹术治疗再发性胆总管结石的疗效及安全性。 方法回顾性分析2014年4月至2018年3月161例再发性胆总管结石患者的临床资料，分为A组(腹腔镜联合内镜治疗，n＝67例)、B组(腹腔镜联合十二指肠镜镜治疗，n＝63例)、C组(传统开腹术，n＝31例)，数据处理应用统计学软件SPSS18.0完成，手术相关指标的比较采用单因素方差分析，两两比较采用LSD－t检验；术后并发症发生率、中转开腹率等采用χ²检验；P<0.05为差异有统计学意义。 结果A组手术时间长于B组和C组(P<0.05)，A组和B组的术中出血量和排气时间均低于C组(P<0.05)，B组的住院时间低于A组和C组(P<0.05)。A组并发症发生率最低，C组最高，差异具有统计学意义(P<0.05)。A组患者结石直径和结石数目均高于B组患者(P<0.05)，A组和B组中转开腹率的差异不明显(P>0.05)。 结论腹腔镜结合内镜与腹腔镜结合十二指肠镜治疗再发性胆总管结石的疗效及安全性均优于开腹治疗，值得推广应用。

Comparison of Efficacy and Safety of Three Kinds of Surgical Treatment for Recurrent Bile Duct Stones

ObjectiveTo compare the efficacy and safety of laparoscopy combined with biliary endoscopy, laparoscopy combined with duodenoscopy and traditional laparotomy surgery for the treatment of recurrent common bile duct stones. MethodsClinical data of 161 patients with common bile duct stones treated in our hospital were collected and divided into group A (laparoscopic combined with endoscopic treatment, n=67 cases), group B (laparoscopic combined with duodenoscopy, n=63 cases) and group C (traditional laparotomy, n=31 cases), the clinical data of the three groups of patients were analyzed and compared using SPSS18.0 statistics software. In this study, the comparison of surgical related indexes was performed by one-way analysis of variance, and multiple comparisons were performed by LSD-t test. The postoperative complication rate and conversion rate were calculated by χ² test. P<0.05 was considered statistically significant. ResultsThe operation time in group A was longer than that in group B and group C (P<0.05). The intraoperative blood loss and exhaust time in group A and B were lower than those in group C (P<0.05). The hospitalization time in group B was lower than those in group A and group C (P<0.05). The incidence of complication was the lowest in group A and the highest in group C, the difference was statistically significant (P<0.05). The stone diameter and number of stones in group A were higher than those in group B (P<0.05). There was no significant difference in conversion rates between group A and group B (P>0.05). ConclusionThe efficacy and safety of laparoscopic combined with biliary endoscopy and laparoscopy combined with duodenoscopy in the treatment of recurrent common bile duct stones are better than traditional laparotomy, it was worthy of promotion and application.