腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的效果

目的 探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果.方法 回顾性分析咸阳市中心医院2012年1月至2015年12月收治的68例胆囊结石合并胆总管结石并接受手术治疗的患者临床资料,根据手术方式,将患者分为腹腔镜微创手术组(腹腔镜组)38例,传统开腹手术组(开腹组)30例.比较两组患者的术中出血量、手术时间、术后排气时间、住院时间、术后并发症以及术后第2天的白细胞(WBC)、中性粒细胞百分比(NEUT％)及C反应蛋白(CRP).结果 腹腔镜组术中出血量、术后排气时间、住院天数、术后伤口疼痛、切口感染例数均少于开腹组,差异有统计学意义(P＜0.05);两组患者在手术时间、术后胆漏、胆管残余结石方面比较差异无统计学意义(P＞0.05);术后第2天,腹腔镜组患者NEUT％、CRP低于开腹组患者,差异有统计学意义(P＜0.05).结论 腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石具有创伤小、痛苦小、术后恢复快等优点,疗效确切,适合临床推广.

Clinical efficacy of laparoscopic combined with choledochoscope surgery in treatment of cholecysolithiasis with choledocholithiasis

Objective To explore the clinical efficacy of laparoscopy combined with choledochoscopy in the treatment of those patients with cholecysolithiasis and choledocholithiasis.Methods The clinical data of 68 patients with cholecysolithiasis and choledocholithiasis,ever treated in our hospitals from Jan 2012 to Dec 2015,were retrospectively analyzed.According to the type of operation,38 patients underwent laparoscopic minimally invasive operation were divided into the laparoscopy group,while other 30 patients treated by conventional open laparotomy were divided into the laparotomy group.The intraoperative blood loss,operative time,intestinal exhaust time,hospitalization days,postoperative complications,together with the white blood cell count (WBC) at 2 days after operation,percent of neutrophils (NEUT％) and levels of C reactive protein (CRP),between the patients of two groups were compared.Results Compared with the laparotomy group,the laparoscopy group had significantly less intraoperative blood loss,shorter intestinal exhaust time and hospitalization days,lower incidences of postoperative wound pain and incision infection (all P ＜ 0.05).But there was no significant difference between the laparoscopy group and the laparotomy group in the operative time,postoperative biliary leakage,and bile duct residual calculi (P ＞ 0.05).At 2 days after surgery,the NEUT％ and CRP in the laparoscopy group were lower than those in the laparotomy group,with significant differences (P ＜ 0.05).Conclusion In treatment of cholecysolithiasis with choledocholithiasis,application of laparoscopy combined with choledochoscopy has advantages of less trauma and pain,faster postoperative recovery and definite therapeutic effects,and is worth of clinical promotion.