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腹腔镜胆囊切除术联合腹腔镜经胆囊管胆总管探查术治疗胆囊结石合并胆总管结石的疗效

The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis.

作者信息

Xu Song, Deng Chuanmin, Tang Kaikai, Nian Gang, Man Zhongran, Yang Song, Xu Ming

机构信息

Department of Hepatobiliary Surgery, Shangyu People's Hospital of Shaoxing, Shaoxing, Zhejiang, China.

Department of Hepatic-Biliary-Pancreatic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China.

出版信息

Updates Surg. 2025 Apr;77(2):493-499. doi: 10.1007/s13304-025-02110-7. Epub 2025 Jan 25.

Abstract

This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.05). The LTCBDE group had shorter surgical time, earlier time to get out of bed, earlier first flatus time, shorter postoperative hospital stays, and earlier removal of abdominal drainage tube compared to the LCBDE and the ERCP + LC groups (all p < 0.05). The average hospitalization cost was also lower in the LTCBDE group (p < 0.05). LTCBDE for the treatment of gallbladder stones with common bile duct stones leads to faster recovery and improved quality of life. It is safe and effective, making it a method worthy of promotion.

摘要

本研究旨在比较腹腔镜胆囊切除术联合腹腔镜经胆囊管胆总管探查术(LTCBDE)、腹腔镜胆总管探查术(LCBDE)及内镜逆行胰胆管造影术(ERCP)治疗胆囊结石合并胆总管结石的疗效。我们基于手术时间、术中出血量、术后恢复指标、总住院费用、手术前后胃肠道生活质量指数(GIQLI)以及术后并发症发生率进行了回顾性对比分析。三组在手术成功率、首次结石清除率、术中出血量、术后并发症发生率及结石复发率方面差异无统计学意义(p>0.05)。与LCBDE组及ERCP+LC组相比,LTCBDE组手术时间更短、下床时间更早、首次排气时间更早、术后住院时间更短且腹腔引流管拔除时间更早(均p<0.05)。LTCBDE组的平均住院费用也更低(p<0.05)。LTCBDE治疗胆囊结石合并胆总管结石可使恢复更快且生活质量得到改善。它安全有效,是一种值得推广的方法。

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