腹腔镜下纤维胆道镜取石与直视下取石在胆囊并胆总管结石治疗中的对比研究

目的 探讨腹腔镜纤维胆道镜取石与直视下取石治疗胆囊合并胆总管结石的临床疗效.方法 选取自2010年5月至2013年5月普外科收治住院的胆囊合并胆总管结石患者100例进行回顾性分析,按手术方式的不同分为观察组（50例）和对照组（50例）.观察组给予腹腔镜纤维胆道镜取石手术治疗,对照组给予腹腔镜直视下取石治疗.观察对比两组手术情况,包括手术时间、术中出血量、术后排气时间、术后并发症的发生情况、住院时间等,并且观察两组术后胆总管通畅率、结石残留率、结石复发率.结果 两组患者的手术时间差异无统计学意义（P＞0.05）,术中出血量、术后排气时间、总住院时间两组差异也无统计学意义（P＞0.05）.观察组术后胆总管通畅率、结石残留率、结石复发率、再次手术患者比例均显著优于对照组,差异有统计学意义（P＜0.05）.观察组术后并发症的发生率为8.0％,显著低于对照组的18.0％,差异有统计学意义（P＜0.05）.结论 腹腔镜手术中纤维胆道镜探查胆管进行取石治疗胆囊并胆总管结石,安全性高、临床疗效显著,且创伤小、并发症少,值得临床推广.

Comparative study of calculus extraction under fiberoptic choledochoscope versus direct vision endoscope in the treatment of cholecystocholedocholithiasis

Objective To compare the clinical efficacies of calculus extraction under fiberoptic choledochoscope versus direct vision endoscope in the treatment of cholecystocholedocholithiasis.Methods During the period of May 2010 and May 2013,a total of 100 patients with cholecystocholedocholi thiasis were retrospectively analyzed.According to surgical approaches,they were divided into study and control groups （n-50 each）.The study group underwent stone extraction under fiberoptic chole dochoscope while the control group did the same under direct vision endoscope.Various surgical pa rameters,including operative duration,intraoperative blood loss volume,postoperative flatus time,occurrences of postoperative complications,hospitalization length,postoperative common bile duct （CBD） patency rate,residual calculus rate and calculus recurrence rate,were recorded and compared for two groups.Results The operative durations showed no significant intergroup difference （P＞ 0.05）.As compared to control group,intraoperative blood loss volume,postoperative flatus time and total hospitalization length were smaller.However the differences were not statistically significant（P ＞0.05）.The study group was superior to the control group with regards to postoperative CBD paten cy rate,residual calculus rate,calculus recurrence rate and re-operation patient percentage.And the differences were statistically significant （P＜0.05）.The incidence of postoperative complications was 8.0％ in study group versus 18.0％ in control group.And the difference was statistically significant （P＜0.05）.Conclusions With a high safety profile,excellent efficacies,minbinvasiveness and fewer complications,calculus extraction under fiberoptic choledochoscope in the treatment of cholecystocho ledocholithiasis is worthy of wider clinical applications.