腹腔镜联合胆道镜经胆囊管微切开胆管取石术治疗肝外胆管结石的临床效果及并发症研究OA

Objective To investigate the clinical efficacy and complications of laparoscopy combined with choledochoscopy for bile duct stone removal via cystic duct micro-incision in the treatment of extrahepatic bile duct stones.Methods A total of 80 patients with extrahepatic bile duct stones who underwent surgical treatment in Nanyang Central Hospital from February 2022 to June 2024 were selected and divided into to the laparoscopic group and the double-endoscopic group according to the double-blind method,with 40 cases in each group.The laparoscopic group was treated with laparoscopic common bile duct exploration,while the double-endoscopic group was treated with laparoscopy combined with choledochoscopy for bile duct stone removal via cystic duct micro-incision.The surgical-related indicators,postoperative recovery,inflammatory response,liver function indicators,prognosis and complications were compared between the two groups.Results The operation time of the double-endoscopic group was significantly shorter than that of the laparoscopic group,and the intraoperative blood loss amount was significantly less than that of the laparoscopic group(P<0.05);the drainage tube indwelling time,recovery time of bowel sounds,postoperative analgesic time and hospitalization time in the double-endoscopic group was significantly shorter than that in the laparoscopic group(P<0.05).3 days after surgery,the levels of interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in the double-endoscopic group were significantly lower than those in the laparoscopic group(P<0.05);3 days after surgery,the level of total bilirubin(TBIL)in the double-endoscopic group was significantly higher than that in the laparoscopic group,and the levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were significantly lower than those in the laparoscopic group(P<0.05).There was no statistically significant difference in the rate of residual stone(0.00%vs.5.00%)and stone recurrence rate(2.50%vs.7.50%)between the double-endoscopic group and the laparoscopic group(P>0.05).The total incidence of complications in the double-endoscopic group was 2.50%,significantly lower than 20.00%in the laparoscopic group(P<0.05).Conclusions Laparoscopy combined with choledochoscopy for bile duct stone removal via cystic duct micro-incision demonstrates significant efficacy and high safety in the treatment of extrahepatic bile duct stones.Meanwhile,this surgical method can significantly reduce intraoperative trauma,shorten postoperative recovery time,lower the inflammatory response of the body,and cause less damage to liver function.