微创技术联合钬激光与传统技术治疗肝内胆管结石的临床比较

目的:探讨微创技术联合钬激光与传统手术治疗肝内胆管结石的临床效果.方法:回顾性分析我院2013年5月至2016年7月收治的肝内胆管结石的45例患者,随机分为两组,其中20例行传统手术(开腹+术中胆道镜技术)(对照组),25例行微创技术(腹腔镜+术中胆道镜技术)联合钬激光碎石术(实验组).结果:实验组术中出血量为(30.23±5.55)mL、术后住院时间为(8.20±1.50)d,切口感染或液化率为0,胆瘘发生率为4％,结石残余率为7％,对照组术中出血量为(51.76±5.92)mL、术后住院时间为(10.25±1.97)d,切口感染或液化率为25％,胆瘘发生率为15％,结石残余率为35％,两组患者在术中出血量、术后住院时间、切口感染或液化及结石残余方面差异有统计学意义(P<0.05).结论:微创技术联合钬激光碎石术在治疗肝内胆管结石方面相比传统手术有术后住院时间短、术中出血少、结石残余率低和术后并发症少等优势,值得临床进一步推广和应用.

The Clinical Comparison between Mini-invasive Technique Combined with Holmium Laser and Traditional Technique in Treatment of Hepatolithiasis

Objective:To explore the clinical effect between mini-invasive technique combined with holmium laser and traditional operation in treating hepatolithiasis. Methods:A retrospective study was carried out on the clinical data of 45 patient s with intrahepatic lithiasis treated by our hospital from May 2013 to July 2016,randomly divided into two groups, of which 20 patients was treated by traditional technique ( open-ab-domen and intraoperative choledochoscope technique) ( control group) and 25 cases underwent mini-invasive technique ( laparoscopy and intraoperative choledochoscope technique) combined with holmium laser lithotrip-sy(observation group). Results:The intraoperative bleeding in observation group was (30.23±5.55) mL, the postoperative hospitalization time was (8.20 ± 1.50) d, the incision infection or liquefaction rate was 0, the incidence of biliary fistula was 4％ and the residual rate of stones was 7％. In the control group,the amout of bleeding in operation was (51.76 ± 5.92) mL, the postoperative hospital stay time was (10.25 ± 1.97) d, the incision infection or liquefaction rate was 25％, the incidence of biliary fistula was 15％ and the residual rate of stones was 35％.There were statistically significantly differences in intraoperative bleeding,postoperative hospitalization time,the incision infection or liquefaction and residual calculus in the two group (P<0.05). Conclusion:Mini-invasive technique combined with holmium laser has the advantages of shorter hospitaliza-tion time, fewer bleeding, low residual calculus and fewer complications than traditional technique in the treat-ment of hepatolithiasis. It deserves further promotion and application.