腹腔镜联合胆道镜经胆管再次手术治疗肝内外胆管结石的安全性和临床疗效

目的探讨腹腔镜联合胆道镜经胆管再次手术治疗肝内外胆管结石的安全性和临床疗效。 方法回顾性分析2015年1月至2017年2月间临床资料完整的80例肝内外胆管结石患者资料，分为开腹组(n＝36)和腹腔镜联合胆道镜手术组(研究组，n＝44)。采用SPSS19.0软件包对数据进行分析，术中术后指标等计量资料采用( ±s)描述，独立t检验。术后结石残留、术后结石复发等并发症资料组间比较采用χ²检验。P<0.05为差异有统计学意义。 结果研究组的手术时间、术中出血量、术后镇痛时间、肛门排气时间、腹腔管拔除时间、T管夹闭时间、住院时间显著低于开腹组(P<0.05)；研究组术后结石残留、结石复发的比例显著低于开腹组(P<0.05)；两组术后并发症的情况差异无统计学意义(P>0.05)。 结论腹腔镜联合胆道镜经胆管再次手术治疗肝内外胆管结石是安全可行的微创手术方式，相较于传统开腹手术其临床效果更显著，具有手术时间短、术中出血量少、术后恢复快、结石残留率和复发率低的优势，具有临床应用和推广价值。

Safety and clinical efficacy of laparoscopy combined with choledochoscopy through bile duct on reoperation of intrahepatic and extrahepatic bile duct stones

ObjectiveTo investigate the safety and clinical efficacy of laparoscopy combined with choledochoscopy through bile duct on reoperation of intrahepatic and extrahepatic bile duct stones. Methods80 patients with intrahepatic and extrahepatic bile duct stones reoperatived in our hospital from January 2015 to February 2017 were divided into open operation group (control group, n=36 case) and laparoscopy combined choledochoscopy group (study group, n= 44). SPSS19.0 software was used to analyze. Intraoperative and postoperative indicators were measured by ( ± s). the two groups was compared with independent t test. Postoperative complications such as residual stones and postoperative stone recurrence were compared with chi square. The difference of P<0.05 was statistically significant. ResultsThe time of operation, the amount of bleeding, the time of postoperative analgesia, the time of anus exhaust, the time of removal of the abdominal tube, the time of T tube closure and the time of hospitalization in the study group were significantly lower than those in the open group (P<0.05). The rate of residual stones and recurrence of stones in the study group was significantly lower than those in the open group (P<0.05); the difference of the complications between the two groups were not statistically significant (P>0.05). Conclusionlaparoscopy combined with choledochoscopy is a safe and feasible minimally invasive procedure for the treatment on reoperation of intrahepatic and extrahepatic bile duct stones. Compared with traditional laparotomy, it has a better clinical effect. It is worthy of clinical application and popularization.