[1]杨军凯郝泽东郭文亮王志强武飚**.同期三镜联合钬激光治疗胆囊结石合并胆总管结石：前瞻性随机对照研究[J].中国微创外科杂志,2025,01(7):398-404.
　Yang Junkai,Hao Zedong,Guo Wenliang,et al.Simultaneous Use of Three Endoscopes Combined With Holmium Laser in the Treatment of Gallstones Complicated With Common Bile Duct Stones: a Prospective Randomized Controlled Study[J].Chinese Journal of Minimally Invasive Surgery,2025,01(7):398-404.
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同期三镜联合钬激光治疗胆囊结石合并胆总管结石：前瞻性随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年7期
页码:
398-404
栏目:
临床论著
出版日期:
2025-07-30

文章信息/Info

Title:
Simultaneous Use of Three Endoscopes Combined With Holmium Laser in the Treatment of Gallstones Complicated With Common Bile Duct Stones: a Prospective Randomized Controlled Study
作者:
杨军凯郝泽东郭文亮王志强武飚**
(太原市中心医院肝胆胰外科山西医科大学第九临床医学院，太原030000)
Author(s):
Yang Junkai;  Hao Zedong;  Guo Wenliang;  et al.
Department of Hepatobiliary Pancreatic Surgery, Taiyuan Central Hospital, Ninth Clinical Medical College of Shanxi Medical University, Taiyuan 030000, China
关键词:
胆囊结石合并胆管结石; 内镜鼻胆管引流术; 钬激光碎石; 腹腔镜胆总管探查术
Keywords:
Gallstones complicated with common bile duct stones; Endoscopic nasobiliary drainage; Holmium laser lithotripsy; Laparoscopic common bile duct exploration
文献标志码:
A
摘要:
目的探讨同期三镜(腹腔镜、胆道镜、十二指肠镜)联合钬激光治疗胆囊结石合并胆总管结石的临床效果。方法采用前瞻性随机对照研究，选取我院2022年8月~2024年1月80例胆囊结石合并胆总管结石，按随机数字表法分为三镜组(n=40)和双镜组(n=40)。三镜组行腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)+腹腔镜胆总管探查术(laparoscopic common bile duct exploration， LCBDE)联合钬激光碎石+胆总管一期缝合+内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)+内镜鼻胆管引流术(endoscopic nasobiliary drainage，ENBD)，双镜组行LC+LCBDE+T管引流术。比较2组患者术中出血量、手术时间、住院时间、住院费用及术后并发症等。结果2组患者术中出血量差异无显著性 ［(55.6±14.3)ml vs.(53.2±16.3)ml，t=0.703，P=0.484］。三镜组手术时间显著长于双镜组［214.5(171.5，2468)min vs.178.0（151.0，227.8)min，Z=-2.069，P=0.039］，住院时间明显短于双镜组［(13.2±3.3)d vs.(16.2±3.7)d，t=3.864，P=0.001］，住院费用显著高于双镜组［39 316.0(32 338.5，43 421.0)元vs.33 717.0(30 873.3，37 813.3)元，Z=-3.272，P=0.001］。2组术后胰腺炎发生率［2.5%(1/40) vs.2.5%(1/40)， χ2=0.000，P=1.000］、胆漏发生率［7.5%(3/40) vs.2.5%(1/40)， χ2=0.263，P=0.615］、结石残留率［7.5%(3/40) vs. 0.0%(0/40)，P=0.241］差异无显著性。三镜组40例随访2～20个月，中位随访时间13个月，术后8个月结石复发1例。双镜组40例随访1～21个月，中位随访时间15个月，术后6、10个月结石复发各1例，2组结石复发率差异无统计学意义［2.5%(1/40) vs.5.0%(2/40)， χ2=0000，P=1.000］。结论LC+LCBDE联合钬激光碎石术+胆总管一期缝合+ERCP+ENBD术治疗胆囊结石伴胆总管结石，可以明显缩短患者住院时间，鼻胆管替代T管，保护Oddi括约肌的功能，更加符合微创理念，值得临床推广应用。
Abstract:
ObjectiveTo investigate the clinical effect of simultaneous use of three endoscopes (laparoscope, choledochoscope, and duodenoscope) combined with holmium laser in the treatment of gallstones complicated with common bile duct stones.MethodsA prospective randomized controlled study was carried out. A total of 80 patients with cholecystolithiasis combined with choledocholithiasis in our hospital from August 2022 to January 2024 were selected and divided into threeendoscope group (n=40) and twoendoscope group (n=40) according to random number table method. Patients in the threeendoscope group underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) combined with holmium laser lithotripsy, primary closure of the common bile duct, endoscopic retrograde cholangiopancreatography(ERCP), and endoscopic nasobiliary drainage (ENBD), while the twoendoscope group underwent LC+LCBDE+Ttube drainage. The intraoperative bleeding volume, operation time, hospitalization time, hospitalization costs, and postoperative complications between the two groups were observed and analyzed.ResultsThere was no significant difference in intraoperative bleeding volume between the two groups ［(55.6±14.3)ml vs. (53.2±16.3)ml, t=0.703, P=0.484］. The operation time of the threeendoscope group was significantly longer than that in the twoendoscope group ［214.5 (171.5, 246.8)min vs. 178.0 (151.0, 227.8)min, Z=-2.069, P=0039］. The length of hospital stay in the three endoscope group was significantly shorter than that in the twoendoscope group ［(132±3.3)d vs. (16.2±37)d, t=3.864, P=0.001］. The hospitalization costs were significantly higher in the threeendoscope group than those in the twoendoscope group ［39 316.0 (32 338.5, 43 421.0) yuan vs. 33 717.0 (30 873.3, 37 813.3) yuan, Z=-3.272, P=0.001］. There were no significant differences in the incidence of postoperative pancreatitis ［2.5%(1/40) vs. 2.5%(1/40), χ2=0.000, P=1.000］, the incidence of bile leakage ［7.5%(3/40) vs. 2.5%(1/40), χ2=0.263, P=0.615］, and residual stone rate ［75%(3/40) vs. 0.0%(0/40), P=0.241］ between the two groups. Forty cases in the threeendoscope group were followed up for 2-20 months, with a median of 13 months. One case of stone recurrence occurred at 8 months after surgery. Forty patients in the twoendoscope group were followed up for 1-21 months, with a median of 15 months. There was 1 case of stone recurrence at 6 and 10 months postoperatively, respectively. There was no statistically significant difference in stone recurrence rate between the two groups ［2.5%(1/40) vs. 5.0%(2/40), χ2=0.000, P=1.000］.ConclusionsLC+LCBDE combined with holmium laser lithotripsy, primary closure of the common bile duct, ERCP, and ENBD in the treatment of cholecystolithiasis and choledocholithiasis can shorten the hospitalization time. The replacement of Ttube with nasobiliary duct protects the function of the Oddi sphincter, which is more in line with the concept of minimally invasive surgery and worthy of clinical application.

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备注/Memo

备注/Memo:
基金项目：太原市科学技术局区域医疗中心科技创新计划项目（202203）**通讯作者，Email:781465428@qq.com
更新日期/Last Update: 2025-09-18