腹腔镜联合胆道镜探查与腹腔镜联合十二指肠镜治疗继发性胆总管结石效果对比分析

目的探讨腹腔镜联合胆道镜与腹腔镜联合十二指肠镜治疗继发性胆总管结石的临床效果。方法选择武警北京总队医院2010年2月-2013年3月采用腹腔镜联合内镜治疗的继发性胆总管结石患者183例，其中采用腹腔镜联合胆道镜探查治疗的91例患者为对照组，采用腹腔镜联合十二指肠镜治疗的92例患者为观察组。观察两组术中情况（手术时间、取石数目、结石直径、T管或鼻胆管放置、术中出血量、中转开腹）与术后恢复情况（住院时间、排气时间、术后胆管结石残留及并发症），并进行对比分析。结果①两组患者术中出血量与中转开腹率比较，差异无统计学意义（P〉0．05）；观察组患者手术时间、取石数目、结石直径、T管或鼻胆管放置率明显低于对照组，差异均有统计学意义（P〈0．05）。②所有患者术后无死亡。观察组术后排气时间、住院时间、术后胆漏发生率明显低于对照组，差异均有统计学意义（P〈0．05）；而观察组术后胆道残石率、胆道感染发生率、胰腺炎发生率高于对照组，差异有统计学意义（P〈0．05）。并发症患者均治愈。结论两种手术各有优缺点，应根据自身掌实际情况筛选病例。

Efficacy comparative analysis of laparoscopic common bile duct explo- ration and laparoscopy combined with duodenoscopy in the treatment of secondary common bile duct calculi

Objective To investigate the clinical efficacy of laparoscopic common bile duct exploration or laparoscopy combined with duodenoscopy in the treatment of secondary common bile duct calculi. Methods 183 patients with sec- ondary common bile duct calculi undergoing the laparoscope combined with introscope from February 2010 to March 2013 were selected, 91 cases with laparoscopic common bile duct exploration were selected as control group, 92 cases by laparoscopy combined with duodenoscopy treatment were chosen as observation group. The condition during opera- tion （the operation time, diameter and number of stone, T pipe or nasobiliary placement rate, amount of bleeding, the conversion rate） and postoperative recovery （the hospitalization time, postoperative exhaust time, postoperative compli- cation, postoperative bile leakage rate and complication rates remaining rateremaining rate） of two groups were observed and compared. Results ①The differences of amount of bleeding and the conversion rate between the two groups were not statistically significant （P 〉 0.05）. The operation time, stone number, stone diameter, T pipe or nasobiliary drainage rate in observation group were all lower than those in control group, the differences were statistically significant （P 〈 0.05）. ②No death was found. The postoperative exhaust time, hospitalization time, postoperative bile leakage rate in observation group were all lower than those in control group, the differences were statistically significant （/9 〈 0.05）. Postoperative biliary residual stone rate, biliary infections incidence, pancreatitis incidence in observation group were all higher than those in control group, the differences were statistically significant （P 〈 0.05）.The patients with compli- cations were all cured. Conclusion Two kinds of operation both have advantage and disadvantage, it is right to select the cases according to the actual situation.