腹腔镜辅助胆道镜下胆总管切开取石的临床研究

目的 探讨腹腔镜辅助胆道镜下胆总管切开取石的可行性及临床应用价值.方法 将我院普外科2009年1月至2010年10月间择期手术的60例胆囊合并胆总管结石患者随机分为腹腔镜辅助胆道镜下胆总管切开取石治疗组(以下简称二镜组)和传统开腹胆囊切除+胆总管切开取石治疗组(以下简称开腹组),对两组手术时间、术后并发症例数、伤口疼痛、术后肛门排气恢复时间、术后住院时间及住院总费用等指标进行分析.结果 两组病例均无死亡,二镜组未发生中转开腹手术.术后随访6个月以上者二镜组21例、开腹组22例.两组的手术时间、住院总费用比较无明显差异.而术后肛门恢复排气时间、伤口疼痛率、术后住院时间、术后并发症发生率比较,二镜组明显优于开腹组(P<0.01).结论 腹腔镜辅助胆道镜下胆总管切开取石是一种新兴的微创手术,只要正确掌握适应证和禁忌证,手术成功率高,并发症少,是目前治疗胆囊合并胆总管结石较为理想的微创手术方式.

Clinical research on laparoscopy-assisted choledochofiberscopic choledocholithotomy

Objective To probe the feasibility and clinical value of laparoscopy-assisted choledochofiberscopic choledocholithotomy.Methods Sixty patients with cholecystolithiasis and choledocholithiasis,who were hospitalized between Jan 2009 and Oct 2010,were randomly and equally divided into two groups.Thirty patients（group A） underwent laparoscopy-assisted choledochofiberscopic choledocholithotomy.Other 30 patients（group B） underwent open cholecystectomy and choledocholithotomy.The patients＇ surgery duration,post-operative complications,incisional pain,hospital charges,hospital time and gastrointestinal function recovery time of both groups were analyzed with SPSS11.0,and there was statistical significance when P0.05.Results There were no case of death in our study.There was no significant difference in surgery duration or hospital charges between the two groups（P0.05）.Patients in group B have longer gastrointestinal function recovery time,more severe incisional pain,longer hospital time and more post-operative complications（P0.01）.Conclusion Laparoscopy-assisted choledochofiberscopic choledocholithotomy is a new type of minimally invasive surgery.With strict operative indications and contraindications,it is an ideal operation with a high success rate for the treatment of cholecystolithiasis with choledocholithiasis.