透明帽辅助胆道镜在内镜保胆取石术中的应用研究*

目的研究透明帽辅助胆道镜在内镜保胆取石术中的作用及意义。方法回顾性分析2018年1月-2018年9月因胆囊结石于该院住院行内镜保胆取石术的100例患者,按是否应用透明帽分为接受腹腔镜联合胆道镜手术组与腹腔镜联合透明帽辅助胆道镜治疗手术组,对比两组在胆囊探查时间、手术并发症发生率、不良反应发生率及术后3个月内结石复发情况等方面的差异。结果两组患者均完成保胆取石手术,其中腹腔镜联合透明帽辅助胆道镜组出现1例患者术后胆漏。两组均未发现因胆道镜操作引起胆囊、胆囊管出血和胆总管损伤等并发症。接受腹腔镜联合胆道镜行保胆取石术患者,平均胆囊探查时间为(27.96±12.24)min,术后出现不良反应2例,术后3个月内随访B超检查胆囊结石患者8例;接受腹腔镜联合透明帽辅助胆道镜治疗的患者,平均胆囊探查时间为(12.04±6.01)min,术后出现不良反应2例,术后3个月内随访B超检查胆囊结石患者1例。腹腔镜联合透明帽辅助胆道镜组的胆囊探查时间及术后3个月内胆囊结石患者人数均明显低于腹腔镜联合胆道镜组。两组患者手术并发症发生率和患者不良反应发生率未见明显差异。结论在腹腔镜联合胆道镜实施保胆取石术中,透明帽辅助胆道镜具有明显优势,具有一定的推广应用价值。

Application of transparent cap assisted choledochoscopy in endoscopic gallbladder-preserving surgery*

Objective To study the role and significance of transparent cap assisted choledochoscopy in endoscopic gallbladder-preserving surgery.Methods A retrospective analysis of 100 patients who underwent endoscopic gallbladder-preserving surgery from January 2018 to September 2018,50 patients underwent laparoscopic choledochoscopy and choledochoscopy,and 50 patients underwent laparoscopic combined with transparent cap-assisted choledochoscopy.By laparoscopic choledochoscopy combined with choledochoscopy assisted or not with a transparent cap.The difference in the time of gallbladder exploration,the incidence of surgical complications,the incidence of adverse reactions and the recurrence of stones within 3 months after surgery were compared.Results One patient developed biliary leak after laparoscopic combined with transparent cap-assisted choledochoscopy.No injury such as gallbladder perforation,cystic duct hemorrhage,and common bile duct injury were found in the two groups due to choledochoscopy.Patients who underwent laparoscope combined with choledochoscopy for gallbladder-preserving surgery were of an average of(27.96±12.24)minutes for gallbladder exploration,2 cases of adverse reactions after operation,and 8 cases of stone recurrence within 3 months of follow-up;Patients treated with laparoscope combined with transparent cap assisted in choledochoscopy,were of an average of(12.04±6.01)minutes for gallbladder exploration,2 cases of adverse reactions occurred after operation,and 1 case of stone recurrence within 3 months of follow-up.The results of two groups were significant different in the time of gallbladder exploration and the recurrence rate of stones within 3 months of follow-up.There was no significant difference between the two groups in the incidence of surgical complications and adverse reactions.Conclusion Compared with laparoscope combined with choledochoscopy,transparent cap-assisted choledochoscopy has a significant advantage in endoscopic gallbladderpreserving surgery,which would be widely used in it.