腹腔镜胆囊切除术中联合超细胆道镜治疗胆囊管结石的疗效

doi:10.3877/cma.j.issn.2095-3232.2026.02.010

目的

探讨腹腔镜胆囊切除术（LC）中联合超细胆道镜治疗胆囊管结石的临床应用价值。

方法

回顾性分析2021年9月至2024年9月在安徽理工大学第一附属医院行LC的62例胆囊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。其中男12例，女50例；年龄24~80岁，中位年龄54岁。按术中是否联合超细胆道镜分为超细胆道镜组26例，对照组36例。两组患者均采用“四孔法”，由同一手术团队完成手术。比较两组患者术中、术后恢复情况以及有无结石残留和继发性胆总管结石等。两组手术时间、住院费用等比较采用t检验；并发症等比较采用Fisher确切概率法。

结果

超细胆道镜组手术时间（77±16） min，明显长于对照组的（66±16） min (t=2.689，P=0.009），超细胆道镜组住院费用（1.3±0.1）万元，亦明显高于对照组的（1.2±0.1）万元（t=2.388，P=0.020）。两组术后均未发生腹腔出血、胆漏、切口感染。对照组术后胆囊管残留结石2例，胆总管继发结石4例；超细胆道镜组术后无胆囊管残留结石和胆总管继发结石，两组术后结石残留或继发性胆总管结石发生率比较差异有统计学意义（P<0.05）。

结论

LC术中联合超细胆道镜治疗胆囊管结石，虽然延长了手术时间和增加了住院费用，但可以有效降低术后结石残留，提高手术安全性，尤其适用于胆囊管多发结石或取石破碎患者。

关键词: 胆结石, 胆囊管结石, 腹腔镜胆囊切除术, 超细胆道镜

Objective

To evaluate the clinical application value of laparoscopic cholecystectomy (LC) combined with ultra-thin choledochoscope in the treatment of cystic duct stones.

Methods

Clinical data of 62 patients with cystic duct stones who underwent LC in the First Affiliated Hospital of Anhui University of Science and Technology from September 2021 to September 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 50 female, aged from 24 to 80 years, with a median age of 54 years. According to whether ultra-thin choledochoscope was adopted during LC, 26 patients were assigned into the ultra-thin choledochoscope group and 36 cases in the control group. For all patients, "four-port LC" was performed by the same team. Intraoperative and postoperative recovery, the presence of residual stones and secondary common bile duct stones were compared between two groups. Operation time and hospitalization expenses were compared by t-test between two groups. The incidence of complications was compared by Fisher's exact test.

Results

The operation time in the ultra-thin choledochoscope group was (77±16) min, significantly longer than (66±16) min in the control group (t=2.689, P=0.009). The hospitalization expense in the ultra-thin choledochoscope group was (1.3±0.1)×10⁴ yuan, significantly higher than (1.2±0.1)×10⁴ yuan in the control group (t=2.388, P=0.020). No abdominal bleeding, bile leakage and incision infection occurred after operation in two groups. In the control group, 2 cases developed residual stones in the cystic duct and 4 cases of secondary common bile duct stones, whereas none in the ultra-thin choledochoscope group. The difference between two groups was statistically significant (both P<0.05).

Conclusions

LC combined with ultra-thin choledochoscope prolongs operation time and increase hospitalization expenses for patients with cystic duct stones, but it can effectively reduce the risk of postoperative residual stones and enhance surgical safety, especially for patients with multiple stones or fragmented stones in the cystic duct.

Key words: Cholelithiasis, Cystic duct stones, Cholecystectomy,laparoscopic, Superfine choledochoscope

图1 一例胆囊管结石LC中联合超细胆道镜取石注：a为离断胆囊管；b为超细胆道镜从胆囊管残端进入探查，红色箭头所示为牵引线；c为取石网篮取出胆囊管结石；LC为腹腔镜胆囊切除术

表1 两组胆囊管结石患者一般资料比较

指标	超细胆道镜组	对照组	统计值	P值
性别(例, 男/女)	5/21	7/29	χ²=0.000	0.983
年龄(岁, $x ¯$ ±s)	55±16	56±12	t=-0.307	0.760
BMI(kg/m², $x ¯$ ±s)	24±3	23±4	t=0.769	0.374
吸烟史(例)	4	5	χ²=0.027	0.869
饮酒史(例)	6	8	χ²=0.006	0.937
高血压病史(例)	5	8	χ²=0.082	0.775
糖尿病病史(例)	6	11	χ²=0.424	0.515
胆囊壁厚度(mm, $x ¯$ ±s)	3.86±0.62	3.94±0.55	t=-0.841	0.129
胆囊管结石数量≥ 2枚(例)	15	18	χ²=0.359	0.549
ALT[U/L, M(Q₁, Q₃)]	43(26, 54)	40(33, 52)	Z=0.235	0.814
AST[U/L, M(Q₁, Q₃)]	50(37, 67)	37(30, 53)	Z=1.842	0.066

表1 两组胆囊管结石患者一般资料比较

指标	超细胆道镜组	对照组	统计值	P值
性别(例, 男/女)	5/21	7/29	χ²=0.000	0.983
年龄(岁, $x ¯$ ±s)	55±16	56±12	t=-0.307	0.760
BMI(kg/m², $x ¯$ ±s)	24±3	23±4	t=0.769	0.374
吸烟史(例)	4	5	χ²=0.027	0.869
饮酒史(例)	6	8	χ²=0.006	0.937
高血压病史(例)	5	8	χ²=0.082	0.775
糖尿病病史(例)	6	11	χ²=0.424	0.515
胆囊壁厚度(mm, $x ¯$ ±s)	3.86±0.62	3.94±0.55	t=-0.841	0.129
胆囊管结石数量≥ 2枚(例)	15	18	χ²=0.359	0.549
ALT[U/L, M(Q₁, Q₃)]	43(26, 54)	40(33, 52)	Z=0.235	0.814
AST[U/L, M(Q₁, Q₃)]	50(37, 67)	37(30, 53)	Z=1.842	0.066

表2 两组胆囊管结石患者手术相关指标比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	住院时间(d, $x ¯$ ±s)	住院费用(万元, $x ¯$ ±s)
超细胆道镜组	26	77±16	10(9, 15)	6.6±2.1	1.3±0.1
对照组	36	66±16	10(5, 10)	7.4±2.8	1.2±0.1
统计值		t=2.689	Z=1.800	t=-1.275	t=2.388
P值		0.009	0.072	0.207	0.020

表2 两组胆囊管结石患者手术相关指标比较

组别	例数	手术时间(min, $x ¯$ ±s)	术中出血量[ml, M(Q₁, Q₃)]	住院时间(d, $x ¯$ ±s)	住院费用(万元, $x ¯$ ±s)
超细胆道镜组	26	77±16	10(9, 15)	6.6±2.1	1.3±0.1
对照组	36	66±16	10(5, 10)	7.4±2.8	1.2±0.1
统计值		t=2.689	Z=1.800	t=-1.275	t=2.388
P值		0.009	0.072	0.207	0.020

图2 一例LC术后胆囊管残留结石患者MRCP 注：红色箭头所示为残留结石；LC为腹腔镜胆囊切除术

图3 一例LC术后胆总管继发结石患者MRCP 注：红色箭头所示为胆总管继发结石；LC为腹腔镜胆囊切除术

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Efficacy of laparoscopic cholecystectomy combined with ultra-thin choledochoscope in the treatment of cystic duct stones

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Efficacy of laparoscopic cholecystectomy combined with ultra-thin choledochoscope in the treatment of cystic duct stones