腹腔镜术中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疗效分析

目的探讨腹腔镜与胆道镜或十二指肠镜联合对继发胆总管结石患者的疗效。方法选择我院2006年1月-2012年1月行腹腔镜联合胆道镜手术的继发性胆总管结石患者78例（A组）;选择同期行腹腔镜联合十二指肠镜手术的继发性胆总管结石患者79例（B组）,对两组的临床疗效进行比较分析。结果两组患者术中出血量、中转开腹、肠功能恢复等项比较,差异无统计学意义（P〉0.05）;A组在术中结石直径、结石数目、住院费用及术后并发症发生率等项目上,差异有统计学意义（P〈0.05）;B组在手术时间、T管的留置、术后胆漏、住院时间等方面优于A组,差异有统计学意义（P〈0.05）。结论两组各具优缺点,根据自身掌握的微创手术技术的实际情况,严格筛选病例,均能体现微创手术的优势;而腹腔镜与胆道镜技术的熟练掌握和团队的密切配合,以及胆总管一期缝合技术的应用,能使腹腔镜胆囊切除＋胆总管切开联合胆道镜探查（LC＋LCBDE）微创手术更胜一筹。

Efficacy analysis of laparoscopic cholecystectomy combined with intraoperative choledochoscopic exploration and laparoscopy combined with duodenoscopy in the treatment of secondary common bile duct calculi

Objective To investigate the efficacy of laparoscope combined with choledochoscopy or duodenoscopy in patients with secondary common bile duct calculi.Methods 78 patients with secondary common bile duct calculi undergoing the laparoscope combined with choledochoscopy from January 2006 to January 2012 were selected as group A,79 patients with secondary common bile duct calculi undergoing the laparoscope combined with duodenoscopy in the same period were selected as group B,the clinical efficacy of the two groups was analyzed.Results The differences of amount of bleeding in operation,conversion rate,recovery of intestinal function in the two groups were not statistically significant（P 0.05）;the differences of diameter and number of stone,hospitalization costs,postoperative complications in group A were statistically significant（P 0.05）;the operation time,retention of T tube,postoperative bile leakage rate,hospitalization time in group B were found better than those in group A,the differences were statistically significant（P 0.05）.Conclusion Two groups have advantage and disadvantage,and they all can reflect their advantage in the case of actual technological situation and strict screening.LC＋LCBDE may be better if the team has advantage of the cooperation,technique of laparoscope combined with choledochoscopy and the primary suture of common bile duct.