标题：腹腔镜下胆囊管取石与胆总管切开取石联合一期缝合治疗胆总管结石合并胆囊结石疗效观察

      作者：周正明 1，简国文 1，王平 2    1.西安市阎良区人民医院外一科，陕西 西安 710089；2.渭南市临渭区妇幼保健计划生育服务中心普外科，陕西 渭南 714000

      卷次： 2019年30卷18期

      【摘要】 目的 研究腹腔镜下胆囊管取石与胆总管切开取石联合一期缝合治疗胆总管结石合并胆囊结石临床疗效。方法 选择2017年1月至2019年2月在西安市阎良区人民医院治疗的胆总管结石并发胆囊结石患者158例为研究对象，按照随机数表法将患者分为对照组与观察组，每组79例。对照组采取腹腔镜下胆总管切开取石术结合一期缝合手术治疗，观察组采取腹腔镜下经胆囊管取石结合一期缝合术治疗。比较两组患者的手术时间、术中出血量、首次排气时间、住院时间、临床疗效以及并发症发生率。结果 观察组和对照组患者的手术时间[(70.37±22.29) min vs (116.83±30.46) min]、术中出血量[(37.94±6.73) mL vs (72.58±13.03) mL]、首次排气时间[(2.05±0.75) d vs(3.58±1.07) d]以及住院时间[(3.94±1.30) d vs (8.37±2.16) d]比较，观察组明显少于对照组差异均有统计学意义(P<0.05)；观察组患者的治疗总有效率为94.94%，明显高于对照组的83.54%，并发症发生率为10.13%，明显低于对照组的24.05%，差异均有统计学意义(P<0.05)。结论 腹腔镜经胆囊管取石治疗胆总管结石合并胆囊结石疗效显著且安全性较高，能大大缩短手术时间、首次排气时间、住院时间，降低术中出血量。
      【关键词】 胆总管结石；胆囊结石；胆囊管取石；胆总管切开取石术；一期缝合；并发症
      【中图分类号】 R657.4+2 【文献标识码】 A 【文章编号】 1003—6350（2019）18—2357—03

Clinical efficacy of laparoscopic cholecystectomy or common bile duct incision combined with primary suture forthe treatment of common bile duct stones complicated with gallbladder stones.
ZHOU Zheng-ming 1, JIAN Guo-wen 1,WANG Ping 2. 1. First Department of General Surgery, the Yanliang District People's Hospital of Xi'an City, Xi'an 710089,Shaanxi, CHINA; 2. Department General surgery, the Linwei District Maternal and Child Health Family Planning ServiceCenter of Weinan City, Weinan 714000, Shaanxi, CHINA
【Abstract】 Objective To study the clinical efficacy of laparoscopic cholecystectomy and common bileduct incision combined with primary suture for the treatment of common bile duct stones combined with gallstones.Methods A total of 158 patients with common bile duct stones complicated with gallstones treated in the YanliangDistrict People's Hospital of Xi'an City from January 2017 to February 2019 were selected. According to the randomnumber table method, the patients were randomly divided into control group and observation group, with 79 patients ineach group. The control group underwent laparoscopic common bile duct incision combined with primary suture, and theobservation group was treated with laparoscopic cholecystectomy combined with primary suture. The operation time, in-traoperative blood loss, initial exhaust time, hospitalization time, clinical efficacy, and complication rate were comparedbetween the two groups. Results In the observation group, the operation time, the intraoperative blood loss, the first ex-haust time, and the hospitalization time were (70.37±22.29) min, (37.94±6.73) mL, (2.05±0.75) d, (3.94±1.30) d, signifi-cantly lower than (116.83±30.46) min, (72.58±13.03) mL, (3.58±1.07) d, (8.37±2.16) d in the control group (P<0.05).The total effective rate of the observation group was 94.94%, significantly higher than 83.54% of the control group (P<0.05). The incidence of complications in the observation group was 10.13%, significantly lower than 24.05% in the con-trol group (P<0.05). Conclusion Laparoscopic cholecystectomy for the treatment of common bile duct stones with gall-bladder stones is effective and safe, which can greatly shorten the operation time, first exhaust time, hospital stay, and re-duce intraoperative blood loss.
      【Key words】 Common bile duct stones; Gallbladder stone; Laparoscopic cholecystectomy; Common bile duct in-cision; Primary suture; Complications