腹腔镜联合纤维胆道镜治疗胆囊结石合并胆总管结石172例临床分析

目的探讨腹腔镜联合纤维胆道镜治疗胆囊结石合并胆总管结石的方法及临床应用价值。方法回顾性分析172例胆囊结石合并胆总管结石患者行腹腔镜胆总管切开纤维胆道镜取石术(腹腔镜组)的临床疗效,并与同期165例常规开腹手术患者(开腹组)进行比较。结果两组手术均获成功,患者恢复良好。腹腔镜组手术时间、术中出血量、术后镇痛率、肛门排气时间、切口感染率、住院天数均优于对照组,有显著性差异(P0.05或P0.01)。腹腔镜组有2例结石残余,开腹组有5例结石残余,组间比较无差异(P0.05)。经平均1.2年(1个月~3年)随访,开腹组有9例复发,腹腔镜无一例复发,两组比较差异显著(P0.01)。结论腹腔镜联合纤维胆道镜是治疗胆囊结石合并胆总管结石安全、有效的方法 ,具有创伤小、痛苦轻、恢复快等微创优势。

Laparoscopic Combined with Choledochoscopic Treatment for Choledocholithiasis (with 172 Cases Report)

Objective To evaluate the clinical effects of the laparoscopic and choledochoscopic treatment for choledocholithiasis.Methods A retrospective analysis was used in 172 cases of gallbladder stone combined with choledocholithiasis underwent laparoscopic and choledochoscopic lithotomy（observation group）.And in the same period,165 cases of conventional open surgery were studied as the control group.Results Both the two operations were successful,and all the patients recovered well.In the observation group,the indexes were significantly better than the control group,such as the operation time,intraoperative blood loss,the postoperative analgesia rate,the time of anal passage,the rate of incisional wound infection and the hospital stay（P〈0.05 or P〈0.01）.But the incidence of the stone residue was not different in the two groups（P〉0.05）,with 2 of the observation group and 5 of the control group.All the patients were followed up for 1 month to 3 years,with 1.2 years in average,there were 9 cases relapsed in the control group which was significantly higher than 0 of the observation group（P〈0.01）.Conclusion The associated treatment of the laparoscopic and choledochoscopic operation for the gallbladder stones and choledocholithiasis is a safe and effective method with advantages of fewer traumas,less pain and rapider recovery.