腹腔镜联合肾镜液电碎石仪在基层医院胆道结石手术的运用

【摘要】〓目的〓探讨与研究基层医院在胆道结石手术中运用腹腔镜联合肾镜液电碎石仪的可行性与实用性。方法〓选取我院于2013年1月至2014年1月在我院行手术治疗的胆囊结石合并肝内外胆管结石患者53例,均采用腹腔镜联合肾镜探查液电碎石仪治疗术式,通过观察患者手术时间、术中术后胆道出血、术后胆道结石残余、术后住院时间。结果〓53例患者均顺利完成手术,无中转开腹。术中35例采用液电碎石,每例碎石次数约3~10次,每次持续放电约2~3秒,其中2例较大者反复击打约15次。术中胆道出血者3例,没有出现难以控制的出血以及胆管穿透或胆管壁撕裂病例。术后平均住院时间7.1±2.6天,无腹腔感染病例。所有患者均得到术后半年随访,2例发现术后结石残余,经消化内镜取石。未发现胆总管狭窄病例。 结论〓腹腔镜联合肾镜液电碎石仪治疗胆道结石,在基层医院中有一定的可行性与实用性。

Studies of laparoscopy combined nephroscopic electrohydraulic lithotripsy in treatment of biliary calculi

Objective To investigate the feasibility and safety in treating biliary calculi by using laparoscopy combined nephroscopic electrohydraulic lithotripsy. Methods Fifty-three patients with cholecystolithiasis and oledocholithiasis from January 2013 to January 2014 were included in the study, and underwent surgical treatment in our hospital by using laparoscopy combined nephroscopic electrohydraulic lithotripsy. The operative time, blood loss, hospital stay, were recorded and analyzed. Results All operations were completed successfully, without conversion to open surgery. Thirty-five cases underwent electrohydraulic lithotripsy for 3-10 times each case. There were 3 cases of biliary tract traumatic hemorrhage during operation and were controlled by proper management. No uncontrolled bleeding, perfoT~tiort of bile duct and biliary tract lacerated wound occurred in operation. The hospital stay was 7.1±2.6 days, without any infection cases. Two cases were found residual bile duct stones and were recovered by treatment with digestive endoscopy. No stricture of common bile duct occurred in 6 months of follow-up. Conclusion Laparoscopic combined nephroscopic electrohydraulic lithotripsy is feasible and safe in surgical treatment of oledocholithiasis.