Abstract：Objective To explore the effect of three kinds of minimally invasive surgical methods for choledocholithiasis with cholecystolithiasis.Methods The clinical data of 85 patients with choledocholithiasis and cholecystolithiasis admitted to Provincial Corps Hospital of Chinese People's Armed Police Force from January 2018 to September 2021 were retrospectively analyzed. According to different surgical methods, they were divided into three groups,30 cases in group A were treated with laparoscopic common bile duct exploration (LCBDE)+T-tube drainage (TD)+laparoscopic cholecystectomy (LC), 30 cases in group B were treated with endoscopicretrograde cholangiopancreatography combined with endoscopic papillary Sphincter incision (ERCP/EST)+laparoscopic cholecystectomy, and 25 cases in group C were treated with laparoscopic common bile duct exploration+primary suture (PS)+laparoscopic cholecystectomy The differences of hospitalization time, hospitalization expenses, preoperative liver function, surgical related conditions, postoperative recovery, and postoperative complications among the three groups of patients were compared and analyzed.Results There was no significant difference in the incidence of preoperative alanine aminotransferase (ALT), aspartate transaminase (AST), direct bilirubin (DBIL), postoperative cholangitis, bile leakage, bleeding, stone residue or overall complications among the three groups. The hospitalization time (14.13±2.50) days, intraoperative bleeding (18.50±7.45) ml, postoperative pain scores at 6, 12, and 24 hours in Group A were significantly higher than those in Group B and Group C. The quality of life scores (67.03±5.54) and abdominal wall aesthetic satisfaction scores (2.50±0.73) were significantly lower than those in Group B and Group C. The differences were statistically significant (P<0.05). The pain scores of Group B at 48 hours after surgery was (0.37±0.77) points, the anal ventilation time was (18.33±5.16) hours, and the time to get out of bed was (9.30±6.53) hours, which were significantly better than those of Group A and Group C (P<0.05). However, the hospitalization cost (27 499±4577) yuan and the incidence of postoperative pancreatitis (13.33%) were significantly higher than those of groups A and C. The surgical time in Group C was (89.20±37.38) minutes, significantly longer than that in Groups A and B, with a statistically significant difference (P<0.05).Conclusions Three surgical methods are safe and effective for the treatment of common bile duct stones combined with gallbladder stones. For patients who require rapid postoperative recovery, beautiful abdominal wall and high quality of life, and meet the indications for PS surgery, it is recommended to use LCBDE+PS+LC surgery.
龚义飞, 孙登群, 张培松, 何新苗, 骆会来. 三种微创手术方法治疗胆总管结石合并胆囊结石的效果[J]. 武警医学, 2023, 34(8): 652-655.
GONG Yifei, SUN Dengqun, ZHANG Peisong, HE Xinmiao, LUO Huilai. Comparison of three minimally invasive surgical methods for choledocholithiasis with cholecystolithiasis. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(8): 652-655.
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