胡长和 方圆 洪士林

【摘要】 目的：探討胆囊结石合并胆总管结石行腹腔镜胆囊切除（LC）+胆总管探查（LCBDE）+一期缝合（PS）治疗的效果。方法：选择2017年2月-2020年4月于本院就诊的胆囊结石合并胆总管结石患者84例，按随机数字表法将其分为治疗组和对照组，每组42例。治疗组行一步法术式治疗，对照组行分步法术式治疗。比较两组术中、术后情况和炎性因子指标，观察并发症发生情况。结果：治疗组残余结石率为2.38%，与对照组的4.76%比较，差异无统计学意义（P>0.05）。两组手术用时、术中出血量比较，差异均无统计学意义（P>0.05）;治疗组住院费用少于对照组，术后住院时间短于对照组，差异均有统计学意义（P<0.05）。术前和术后1 d，两组IL-6、CRP水平比较，差异均无统计学意义（P>0.05）;术后1 d，两组IL-6、CRP水平均高于术前，差异均有统计学意义（P<0.05）。两组术后并发症发生率比较，差异无统计学意义（P>0.05）。结论：一步法术式与分步法术式治疗胆囊结石合并胆总管结石患者效果相当，安全性相似，但前者存在治疗费用低、住院时间短等优点。

【关键词】 胆囊结石 胆总管结石 腹腔镜胆囊切除 胆总管探查 一期缝合

Clinical Observation of LC+LCBDE+PS in the Treatment of Cholecystolithiasis Complicated with Common Bile Duct Stones/HU Changhe， FANG Yuan， HONG Shilin. //Medical Innovation of China， 2021， 18（28）： 0-064

[Abstract] Objective： To investigate the effect of laparoscopic cholecystectomy （LC） + common bile duct exploration （LCBDE） + primary suture （PS） for cholecystolithiasis complicated with common bile duct stones. Method： A total of 84 patients with cholecystolithiasis complicated with common bile duct stones treated in our hospital from February 2017 to April 2020 were selected， they were divided into treatment group and control group according to random number table method， 42 cases in each group. The treatment group was treated with one-step method， the control group was treated with step-step method. The intraoperative and postoperative conditions and inflammatory factors of the two groups were compared， and the incidence of complications was observed. Result： The residual stone rate in the treatment group was 2.38%， compared with 4.76% in the control group， there was no significant difference （P>0.05）. Comparison of operative time and intraoperative blood loss between the two groups， there were no significant differences （P>0.05）; the hospitalization cost of the treatment group was less than that of the control group， the postoperative hospitalization time was shorter than that of the control group， the differences were statistically significant （P<0.05）. Before and 1 day after surgery， comparison of IL-6 and CRP levels between the two groups， there were no significant differences （P>0.05）; 1 day after surgery， IL-6 and CRP levels in both groups were higher than those before surgery， the differences were statistically significant （P<0.05）. Comparison of postoperative complication rate between the two groups， there was no significant difference （P>0.05）. Conclusion： One-step and step-step methods have similar efficacy and safety in the treatment of patients with cholecystolithiasis complicated with choledocholithiasis， but the former has advantages of low treatment cost and short hospitalization time.

[Key words] Cholecystolithiasis Common bile duct stones Laparoscopic cholecystectomy Common bile duct exploration Primary suture

First-author’s address： Leping Hospital of Traditional Chinese Medicine， Leping 333300， China

doi：10.3969/j.issn.1674-4985.2021.28.015

胆囊结石是由胆囊内结石所致疾病，部分患者会同时患有胆总管结石，机体内结石难以自行排出，易诱发疼痛、寒战、黄疸等，若结石不及时取出，将胆道梗阻解除，易诱发肝硬化、胆道出血、全身感染、急慢性胆管炎等疾病，严重危害患者身体健康[1-3]。胆囊结石合并胆总管结石易反复发作，病情迁延难愈，需尽早治疗。以往临床对于本病患者多使用常规开腹手术治疗，但具有手术创伤大、并发症多、恢复时间长等不足[4-5]。……