腹腔镜辅助胆道镜、完全腹腔镜及开腹手术治疗胆石症的对比研究

目的探讨腹腔镜联合胆道镜、完全腹腔镜及传统开腹手术治疗胆石症的效果。方法 2008年1月～2011年6月我院择期治疗的胆石症患者90例根据治疗方法不同分为三组,微创联合组（28例）采取腹腔镜辅助胆道镜治疗;完全腹腔镜组（31例）采取完全经腹腔镜手术治疗;传统手术组（31例）采取传统开腹手术治疗。结果三组患者均手术成功,无死亡。与传统手术组相比,微创联合组及完全腹腔镜组手术时间明显缩短[（68.0±2.0）、（53.0±6.0）、（62.0±4.0）min,P〈0.05]。微创联合组及完全腹腔镜组术中出血量少于传统手术组[（10.0±2.0）、（9.0±2.8）、（18.0±3.2）mL,P〈0.05）。同时,结石取净率在微创联合组、完全腹腔镜组及传统手术组分别为100%、93%、100%,差异无统计学意义（P=0.109）。三组术后均无并发症发生。结论腹腔镜辅助胆道镜,完全腹腔镜及传统开腹手术均可安全有效的治疗胆石症,但腹腔镜辅助胆道镜治疗创伤小,更利于患者恢复健康。

Comparison study on laparoscopic-assisted choledochoscope,laparoscope and laparotomy in the treatment of cholelithiasis

Objective To compare the effectiveness of laparoscopic-assisted choledochoscope,laparoscope and laparotomy in the treatment of cholelithiasis.Methods 90 patients with cholelithiasis in our hospital from January 2008 to June 2011 were divided into three groups: minimally invasive joint group(n = 28) was given laparoscopic-assisted choledochoscope;laparoscope group(n = 30) was given laparoscopic surgery;laparotomy surgery group(n = 31) was given open surgery.Results There was no deaths occurred with all successful operation,Compared with laparotomy surgery group,the operation time in minimally invasive joint group and laparoscope group reduced obviously [(68.0±2.0),(53.0±6.0),(62.0±4.0) min respectively,P < 0.05],and the operating hemorrhage of minimally invasive joint group and laparoscope group were lower than that of laparotomy surgery group [(10.0±2.0),(9.0±2.8),(18.0±3.2) mL respectively,P < 0.05].At the same time,the clear rate of biliary calculus were 100% in minimally invasive joint group,93% in laparoscope group and 100% in laparotomy surgery group(P = 0.109).There was no complication in the three groups.Conclusion All the aparoscopic-assisted choledochoscope,laparoscope and laparotomy are efficient therapy in the treatment of cholelithiasis,but laparoscopic-assisted choledochoscope had less injuries and is much beneficial for the recovery of patients.