腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石临床疗效观察

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疗效。方法选取2010年2月～2012年6月新疆医科大学附属中医医院收治的胆囊结石合并胆总管结石患者68例，随机分为两组，观察组34例采用腹腔镜联合胆道镜治疗。对照组34例采用常规的开腹手术取石。观察两组患者手术时间、术后住院时间、胃肠功能恢复时间、术中出血量、术中补液量及术后并发症情况。结果观察组与对照组患者手术时间[（131．5±4．3）、（123．4±3．9）min]比较，差异无统计学意义（P〉0．05）。观察组胃肠功能恢复时间、住院天数[（22．9±5．7）h、（5．6±2．8）d1均优于对照组[（68．9±6．8）h、（14．6±7．3）d]，差异均有统计学意义（P〈0．05）。观察组患者术中出血量[（28．5±4．7）mL]、术中补液量[（2500±400）mL]均少于对照组[（79．8±7．5）、（3800±600）mL]，差异均有统计学意义（均P〈0．05）。观察组患者术后并发症总发生率[8．82％（3／34）]低于对照组[41．18％（16／34）1，差异有统计学意义（P〈0．05）。结论腹腔镜联合胆道镜治疗胆结石合并胆总管结石是一种安全、有效、可行的、在临床上值得推广的微创治疗方法。

Observation on clinical curative effect of aparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and choledocholithiasis

Objective To discuss the clinical curative effect of aparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and choledocholithiasis. Methods 68 patients diagnosed as cholecystolithiasis and choledocholithiasis in Traditional Chinese Medicine Hospital Affiliated to Xingjiang Medical University from February 2010 to June 2012 were selected and randomly divided into experimental group and control group. 34 patients in experimental group were treated with laparoscopy combined with choledochoscopy, 34 patients in control group were received routine cholecystectomy and choledocholithotomy. Operating time, postoperative hospitalization stay, recovery time of gastrointestinal functions, perioperative bleeding volume, intraoperative rehydration fluids, postoperative complications were observed and compared. Results The difference of operating time in experimental group and control group [（131.5±4.3）, （123.4±3.9） mini was not statistically significant （P 〉 0.05）. Recovery time of gastrointestinal functions and postoperative hospitalization stay in experimental group [（22.9±5.7） h, （5.6±2.8） d] were all better than those in control group [（68.9±6.8） h, （14.6±7.3） d], the differences were statistically significant （P 〈 0.05）; perioperative bleeding volume and intraoperative rehydration fluids in experimental group [（28.5±4.7）, （2500±400） mL] were all lower than those in control group [（79.8±7.5）, （3800±600） mL], the differences were statistically significant （P 〈 0.05）. The total incidence rate of postoperative complications in experimental group [8.82% （3/34）] was lower than that in control group [41.18% （16/34）], the difference was statistically significant （P 〈 0.05）. Conclusion Aparoscopy combined with choledochoscopy is effective and safe in treating choledocholith. It has shorter recovery time and less complications, and it is the preferred treatment of choledocholith complicated with choledocholith. It is worthy of promotion in the surgery.