黄广才

摘  要：目的  探讨为肝外胆管结石患者实施腹腔镜联合胆道镜下胆管一期缝合治疗与T管引流治疗的效果及两者对白细胞介素-6（IL-6）及C-反应蛋白（CRP）水平的影响。方法  选取2019年3月～2020年3月莘县中心医院收治的110例肝外胆管结石患者为研究对象，采用随机数表法分为观察组和对照组，每组55例。观察组采用腹腔镜联合胆道镜下胆管一期缝合法治疗，对照组患者放置T管引流，对比两组患者围术期的相关指标、血清炎性因子水平以及并发症发生率。结果  观察组患者手术用时、腹腔引流时长、肛门首次排气时间及住院时长均短于对照组，术后3天观察组患者的IL-6及CRP水平均低于对照组，观察组患者并发症的发生率低于对照组，差异均有统计学意义（P<0.05）。结论  采用腹腔镜联合胆道镜下胆管一期缝合法对肝外胆管结石患者进行治疗能够有效缩短其疾病恢复时间，减轻机体炎症反应，同时此法具有较低的并发症发生率，值得应用。

关键词：肝外胆管结石;腹腔镜;胆道镜;T管引流

中图分类号：R657.4+2    文献标识码：A    文章编号：1009-8011（2021）-15-0003-03

Comparison of laparoscopic combined with choledochoscopic primary suture and T-tube drainage in the treatment of extrahepatic bile duct stones

HUANG Guang-cai

（Department of General Surgery， The Second People's Hospital of Shen County， Shandong Liaocheng，252423， China）

Abstract： Objective  To investigate the effect of laparoscopic combined with choledochoscopic bile duct primary suture and T-tube drainage in the treatment of extrahepatic bile duct stones， and the influence of them on the levels of IL-6 and CRP. Methods  110 patients with extrahepatic bile duct stones from March 2019 to March 2020 were selected and randomly divided into two groups， 55 cases in both groups. The observation group was treated with laparoscopy combined with choledochoscopy， and the control group was treated with T-tube drainage. The perioperative related indicators， serum inflammatory factors and the incidence of complications of the two groups were compared. Results  The operation time， abdominal drainage time， first anal exhaust time and hospitalization time of the observation group were shorter than those of the control group. The levels of IL-6 and C-reactive protein of the observation group were significantly lower than those of the control group 3 days after operation， and the incidence of complications was lower than that of the control group，with statistical significance（P<0.05）. Conclusion  One stage suture of bile duct under laparoscope combined with choledochoscope for the treatment of extrahepatic bile duct stones can effectively shorten the recovery time of the disease， reduce the body's inflammatory reaction， and has a lower incidence of complications， which is worthy of application.

Keywords： extrahepatic bile duct stones; laparoscopy; choledochoscope; T-tube drainage

早期肝外膽管结石症状不易被发现，待病情严重后可能引发胰腺炎、急性胆管炎等各种并发症，对患者的生命安全产生不利影响。现今临床主要采取手术方式干预，但常规开腹疗法存在创口明显、术后并发症多的弊端[1]。随着腹腔镜技术的发展，该手术方式已广泛应用于胆管结石的治疗中，但选择T管引流术还是腹腔镜下胆管一期缝合为肝外胆管结石患者进行治疗临床上仍存有争议。基于此，本研究采用腹腔镜联合胆道镜下胆管一期缝合法对该类患者实施干预，并通过对比放置T管引流，对比两者的应用效果，现报道如下。……