Clinical value of laparoscopy combined with duodenoscopy in the treatment of choledocholithiasis
ZHAO Zhixin CHEN Gengzhen▲ XU Ruirui ZHUANG Chaoping HAN Hui WANG Meizi YOU Shaoqin #br#
Department of Endoscopic Vascular Surgery, the Second Affiliated Hospital of Shantou University Medical College, Guangdong Province, Shantou 515041, China
Abstract:Objective To investigate the clinical value of laparoscopy combined with duodenoscopy in the treatment of choledocholithiasis. Methods A total of 60 patients with choledocholithiasis admitted to the Second Affiliated Hospital of Shantou University Medical College from July 2019 to February 2021 were selected as the research subjects and they were divided into two groups according to the random number table method, with 30 cases in each group. The research group underwent laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE)+endoscopic nasobiliary drainage (ENBD), the control group received LC+LCBDE+T tube drainage. The intraoperative and postoperative conditions of the two groups were compared. Results The extubation time and hospital stay in the study group were shorter than those in the control group, and the hospitalization costs was less than those in the control group, with statistically significant differences (P < 0.05). There were no significant differences in operation time, intraoperative blood loss, bile drainage, and gastrointestinal recovery time between the two groups (P > 0.05). Postoperative re-examination found that the increase rate of blood and urine amylase and abnormal liver function rate in the study group were lower than those in the control group, and the differences were statistically significant (P < 0.05). There were no statistical significance difference in the incidence of postoperative pancreatitis and bile leakage between the two groups (P > 0.05). Conclusion Laparoscopic combined with duodenoscope placement of nasobiliary duct is safe and effective in the treatment of choledocholithiasis, and have quickly recover after operation with drfinite curative effect.
赵芝鑫 陈耿臻▲ 许锐锐 庄潮平 韩慧 王梅子 游少钦 . 腹腔镜术中联合十二指肠镜在治疗胆总管结石中的临床价值[J]. 中国医药导报, 2022, 19(22): 92-95.
ZHAO Zhixin CHEN Gengzhen▲ XU Ruirui ZHUANG Chaoping HAN Hui WANG Meizi YOU Shaoqin . Clinical value of laparoscopy combined with duodenoscopy in the treatment of choledocholithiasis . 中国医药导报, 2022, 19(22): 92-95.
[1] 李华林,陈安平,胡铤.腹腔镜胆总管探查鼻胆管引流与T管引流的疗效比较[J].中国内镜杂志,2016,22(5):12-16.
[2] 周皓岚,付英,黄涛.腹腔镜下胆总管探查一期缝合治疗肝外胆管结石的安全性研究[J].中国内镜杂志,2015,21(3):311-314.
[3] Loor MM,Morancy JD,Glover JK,et al. Single-setting endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy improve the rate of surgical site infection [J]. Surg Endosc,2017,31(12):5135-5142.
[4] Zhou Y,Zha WZ,Wu XD,et al. Three modalities on management of choledocholithiasis:A prospective cohort study [J]. Int J Surg,2017,44:269-273.
[5] 胡水根,朱婷婷,徐小平,等.胆道镜或ERCP联合腹腔镜治疗胆囊结石合并胆总管结石的临床体会[J].临床外科杂志,2019,27(7):620-621.
[6] 成正军,赵晨晖,王亚峰,等.双镜下钬激光碎石治疗肝内外胆管结石120例分析[J].中国现代普通外科进展,2020,23(3):186-189.
[7] 高秀珍,陈益清,张诚,等.DSA下导丝引出法在困难性鼻胆管口鼻转换中的临床研究[J].中国内镜杂志,2020, 26(5):78-82.
[8] Pan L,Chen M,Ji L,et al. The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up-to-date Meta-analysis [J]. Ann Surg,2018,268(2):247-253.
[9] Williams E,Beckingham I,El Sayed G,et al. Updated guideline on the management of common bile duct stones (CBDS)[J]. Gut,2017,66(5):765-782.
[10] Chan DS,Jain PA,Khalifa A,et al. Laparoscopic common bile duct exploration [J]. Br J Surg,2014,101(11):1448-1452.
[11] Koc B,Karahan S,Adas G,et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis:a prospective randomized study [J]. Am J Surg,2013,206(4):457-463.
[12] 于涛,陈晓宁,孙世波.胆总管结石的微创治疗现状与进展[J].腹腔镜外科杂志,2020,25(10):792-795.
[13] Qin A,Wu J,Qiao Z,et al. Comparison on the Efficacy of Three Duct Closure Methods after Laparoscopic Common Bile Duct Exploration for Choledocholithiasis [J]. Med Sci Monit,2019,25:9770-9775.
[14] 赵芝鑫,陈耿臻,许锐锐.术中鼻胆管替代传统T管在腹腔镜胆囊切除+胆总管切开一期缝合的应用效果[J].中国当代医药,2021,28(21):75-79.
[15] 徐垚,安东均,冯金鸽,等.胆总管探查一期缝合鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石的临床研究[J]. 腹腔镜外科杂志,2020,25(4):288-292.
[16] 周雪婷,毛蕾,李戟纰,等.腹腔镜胆总管探查联合鼻胆管引流与T管引流术治疗胆总管结石临床疗效的Meta分析[J].中华消化外科杂志,2020,19(8):856-868.
[17] 王财庆,庄端明,陈功.三镜联合“一步法”与ERCP/EST联合LC在胆总管结石合并胆囊结石治疗中的对照分析[J].中国内镜杂志,2021,27(1):64-69.
[18] 张昌生,张学贞,韩宗明,等.腹腔镜和胆道镜及十二指肠镜联合应用对胆囊结石合并胆总管结石的疗效[J]. 中国现代普通外科进展,2019,22(1):44-46,49.
[19] 王云峰,徐斌,王杰,等.腹腔镜、胆道镜及十二指肠镜联合免T管引流对胆囊结石合并胆总管结石的治疗效果分析[J].临床肝胆病杂志,2021,37(4):872-876.
[20] 管辉球,景岚,徐锁青.胆总管一期缝合经胆囊管胆管引流与鼻胆管引流的对比研究[J].中华外科杂志,2018, 56(2):130-134.
[21] Navaratne L,Martinez Isla A. Transductal versus transcystic laparoscopic common bile duct exploration:an institutional review of over four hundred cases [J]. Surg Endosc,2021,35(1):437-448.
[22] Lyon M,Menon S,Jain A,et al. Use of biliary stent in laparoscopic common bile duct exploration [J]. Surg Endosc,2015,29(5):1094-1098.
[23] Zhang X,Zhang L,Yu Y,et al. Human fibrin sealant reduces post-operative bile leakage of primary closure after laparoscopic common bile duct exploration in patients with choledocholithiasis [J]. J Minim Access Surg,2019, 15(4):320-324.
[24] 万健,贺明连,金少纯,等.顺行鼻胆管引流术在腹腔镜胆道探查胆总管一期缝合术中的应用[J].中国普通外科杂志,2021,30(2):133-139.
[25] 谢江,柳晓丹,饶小龙,等.不同微创手术方法治疗胆囊结石并胆总管结石疗效的比较[J].中国普通外科杂志,2021,30(9):1121-1126.
[26] 王玉振,孙风林,司保达.腹腔镜胆道镜联合治疗胆囊结石合并胆总管结石的临床效果[J].中国当代医药,2022,29(6):52-54.
[27] 汪启乐,冯伟,仇毓东,等.术中鼻胆管引流术在胆总管结石合并胆囊结石一期缝合术中的应用[J].中华普外科手术学杂志(电子版),2018,12(6):497-499.
[28] 刘宜兵,戴璟瑜,王晶.ERCP取石后不同时机行腹腔镜胆囊切除术对老年胆囊结石合并胆总管结石患者术后恢复的影响[J].中国医药科学,2021,11(21):225-228.
[29] 冯艳,张明雄,朱亚,等.LC+LCBDE和ERCP/EST+LC治疗胆囊结石合并胆总管结石疗效的Meta分析[J].中国临床研究,2020,33(1):45-50.