腹腔镜外科杂志2025，Vol.30Issue(11)：801-808,8.DOI:10.13499/j.cnki.fqjwkzz.2025.11.801
腹腔镜下不同术式治疗继发性胆总管结石的效果及术后残余结石的影响因素分析
Therapeutic efficacy of different laparoscopic procedures on secondary choledocholithiasis and influencing factors for postoperative residual stone
摘要
Abstract
Objective:To compare the therapeutic efficacy between laparoscopic transcystic common bile duct exploration(LTCBDE)and laparoscopic common bile duct exploration(LCBDE)in the treatment of secondary choledocholithiasis,and to explore the influencing factors for postoperative residual stones.Methods:A retrospective analysis was conducted on the clinical data of patients with cholecystolithiasis complicated by secondary choledocholithiasis admitted from Oct.2022 to Oct.2024.Patients were divided into LTCBDE group and LCBDE group according to the surgical method.After propensity score matching,the clinical data of the two groups were compared,and repeated measures analysis of variance was performed for serum inflammatory factors and liver function indicators.Univariate and multivariate logistic regression analyses were used to identify factors influencing the occurrence of postoperative residual stones.Results:After propensity score matching,60 patients were enrolled in each group.After matching,there were no statistically sig-nificant differences in the general characteristics between the two groups(P>0.05),indicating comparability.Compared with the LCBDE group,the LTCBDE group had shorter operation time,postoperative hospital stay,and gastrointestinal function recovery time,as well as less intraoperative blood loss,lower postoperative residual stone rate,and lower total incidence of complications(P<0.05).For tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),ALT,AST and TBIL in the LTCBDE group and LCBDE group,the time effect,inter-group effect,and interaction effect were all statistically significant(P<0.001).Cystic duct diameter,common bile duct diameter,common bile duct stone diameter,intraoperative blood loss,preoperative levels of IL-6,TNF-α,ALT,TBIL,and the LTCBDE approach were identified as independent influencing factors for the occurrence of postoperative residual stones(P<0.05).Conclusions:Compared with LCBDE,LTCBDE in the treatment of secondary choledocholithiasis is associated with a lower postoperative residual stone rate,less trauma,fewer complications,and better therapeutic efficacy.The occurrence of postoperative residual stones is jointly influenced by multiple factors,including biliary tract anatomical structure,stone characteristics,surgical procedures,and the patient physiological status.关键词
继发性胆总管结石/腹腔镜检查/经胆囊管胆总管探查术/术后残石率Key words
Secondary choledocholithiasis/Laparoscopy/Transcystic common bile duct exploration/Postoperative residual stone rate分类
医药卫生引用本文复制引用
付丽坤,冯钟煦,邹春燕,张利利,李莉..腹腔镜下不同术式治疗继发性胆总管结石的效果及术后残余结石的影响因素分析[J].腹腔镜外科杂志,2025,30(11):801-808,8.基金项目
秦皇岛市科技局科学技术研究与发展计划自筹经费项目(202101A155) （202101A155）
