目的: 探讨四种术式在治疗胆囊结石合并肝外胆管结石(CCL)中的应用价值。方法: 回顾性分析160例CCL患者的临床资料。根据术式的不同把患者分为A、B、C、D组,每组40例。A组行开腹胆囊切除术(OC)＋胆总管切开胆管镜探查(OCBDE)＋T管引流(TTD),B组行腹腔镜胆囊切除术(LC)＋胆总管切开胆管镜探查(LCBDE)＋TTD,C组行LC＋LCBDE＋胆管一期缝合(PDC),D组行LC＋经胆囊管胆管镜探查(LTCBDE)。统计对比四组的手术相关指标、肝功能指标、应激反应指标、并发症和2年胆管结石累积复发情况。结果: 与A组比较,C、D组的手术时间均缩短,B、C、D组的住院时间、腹腔引流时间、恢复正常生活时间缩短,术后3 d空腹血糖、术后3 d血浆皮质醇、术后3 dC反应蛋白、并发症总发生率均明显低,但住院费用均高(P＜0.05)。与B组比较,C、D组的手术时间、住院时间、腹腔引流时间、恢复正常生活时间缩短,住院费用、术后3 d空腹血糖、术后3 d血浆皮质醇、术后3 dC反应蛋白均明显低(P＜0.05)。A、B、C、D组术后3 d的AST、ALT、总胆红素均明显低于术前(P＜0.05)。结论: 四种术式各有优缺点,总体来看LC+LCBDE+PDC和LC+LTCBDE最优,其次为LC+LCBDE+TTD。
Objective: To investigate the application value of four surgical methods in cholecystolithiasis combined with extrahepatic bile duct stones (CCL). Methods: The clinical data of 160 patients with CCL were analyzed retrospectively. According to the different operation methods, the patients were divided into A, B, C and D groups, and 40 cases in each group. Group A was treated with open cholecystectomy (OC)+open cholecystectomy choledocholithotomy with exploration (OCBDE)+T-tube drainage (TTD). Group B was treated with laparoscopic cholecystectomy (LC)+laparoscopic cholecystectomy choledocholithotomy with exploration (LCBDE)+TTD. Group C was treated with LC+LCBDE+primary duct closure (PDC). Group D was treated with LC+Laparoscopictranscystic duct common bile duct exploration (LTCBDE). The operation related indexes, liver function indexes, stress response indexes, complications and 2-year cumulative recurrence of bile duct stones in the four groups were compared. Results: Compared with group A, group C and group D had shorter hospitalization time, and group B, group C and group D had shorter abdominal drainage time and recovery time, and significantly lower fasting blood glucose 3 days after operation, plasma cortisol 3 days after operation, C-reactive protein 3 days after operation and total incidence of complications, but longer operation time and higher hospitalization expenses (P＜0.05). Compared with group B, group C and group D had shorter operation time, hospitalization time, abdominal drainage time and recovery time, and also had lower hospitalization expenses, fasting blood glucose 3 days after operation, plasma cortisol 3 days after operation, C-reactive protein 3 days after operation (P＜0.05). The AST, ALT and total bilirubin of group A, group B, group C, group D 3 days after operation were significantly lower than thsoe before operation (P＜0.05). Conclusions: Each of the four methods has its own advantages and disadvantages. In general, LC+LCBDE+PDC and LC+LTCBDE are the best, followed by LC+LCBDE+TTD.
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