探讨腹腔镜胆囊切除胆道探查一期缝合治疗胆囊结石合并胆总管结石的安全性和疗效。

回顾性分析2017年6月至2019年3月湖南师范大学附属第一医院收治的100例胆囊结石合并胆总管结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。根据治疗方法不同分为腔镜组和开腹组，各50例。腔镜组男31例，女19例；年龄24～74岁，中位年龄47岁；采用腹腔镜胆囊切除+胆道探查取石术，一期缝合。开腹组男32例，女18例；年龄25～74岁，中位年龄47岁；采用开腹胆囊切除+胆道探查取石术+T管引流。观察两组围手术期情况和疗效。两组手术时间、术中出血量等比较采用t检验，治疗总有效率、并发症发生率比较采用χ²检验。

腔镜组平均手术时间、术中出血量、排气时间、术后住院时间分别为（90±17）min、（43±13）ml、（31±5）h、（7.7±1.2）d，明显少于开腹组的（118±21）min、（103±26）ml、（48±8）h、（9.9±1.6）d（t=-3.22，-6.35，-5.47，-3.48；P<0.05）。腔镜组总有效率为96%（48/50），明显高于开腹组的78%（39/50） （χ²=7.16，P<0.05）。腔镜组并发症发生率为6%（3/50），明显低于开腹组的20%（10/50） （χ²=4.33，P<0.05）。

对于胆囊结石合并胆总管结石患者，与开腹比较，腹腔镜胆囊切除胆道探查一期缝合治疗效果好，具有微创、恢复快、安全性高等优势。

To evaluate the safety and efficacy of laparoscopic cholecystectomy, common bile duct exploration combined with primary suture for cholecystolithiasis complicated with choledocholithiasis.

Clinical data of 100 patients with cholecystolithiasis complicated with choledocholithiasis admitted to the First Affiliated Hospital of Hunan Normal University from June 2017 to March 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatments, all patients were divided into laparoscopic group (n=50) and open surgery group (n=50). In the laparoscopic group, 31 patients were male and 19 female, aged 24-74 years with a median age of 47 years. Laparoscopic cholecystectomy, common bile duct exploration combined with primary suture were performed. In the open surgery group, 32 cases were male and 18 female, aged 25-74 years with a median age of 47 years. Open cholecystectomy, common bile duct exploration combined with T-tube drainage were performed. Perioperative conditions and clinical efficacy were observed in two groups. The operation time and intraoperative blood loss between two groups were statistically compared by t test. The total effective rate and incidence of postoperative complications were statistically compared by Chi-square test.

The average operation time, intraoperative blood loss, exhaust time and length of postoperative hospital stay in the laparoscopic group were (90±17) min, (43±13) ml, (31±5) h and (7.7±1.2) d, significantly less than those in the open surgery group (118±21) min, (103±26) ml, (48±8) h and (9.9±1.6) d, respectively (t=-3.22, -6.35, -5.47, -3.48; P<0.05). The total effective rate in the laparoscopic group was 96%(48/50), significantly higher than 78%(39/50) in the open surgery group (χ2=7.16, P<0.05). The incidence of postoperative complications in the laparoscopic group was 6%(3/50), significantly lower than 20%(10/50) in the open surgery group (χ2=4.33, P<0.05).

Compared with open surgery, laparoscopic cholecystectomy, common bile duct exploration combined with primary suture has the advantages of higher efficacy, minimally invasive, quicker recovery and higher safety in the treatment of cholecystolithiasis complicated with choledocholithiasis.