电子胆道镜与输尿管硬镜在腹腔镜胆管探查中的应用

目的探讨电子胆道镜与输尿管硬镜在腹腔镜胆管探查取石术（LCBDE）中的优越性。方法常规采用腹腔镜四孔法完成手术，显露并纵向切开胆总管前壁，甲组患者（31例）通过输尿管硬镜探查取石，乙组患者（30例）通过电子胆道镜探查取石，取石后均常规安置T管和腹腔引流管。手术后3个月和1年时进行电话及门诊随访，做出临床观察和评估。观察指标为：手术时间、术中出血量、术后使用镇痛的频率、术后胃肠功能恢复时间、术后住院天数、住院费用、手术并发症（胆管残留结石、胆管损伤、胆漏、胆管狭窄、切口感染）、学习曲线等。将两组数据进行统计学处理和分析。结果甲组中有2例患者改用电子胆道镜取石成功。术中出血量、术后使用镇痛的频率、术后胃肠功能恢复时间、术后住院天数、住院费用、手术并发症（胆管残留结石、胆管损伤、胆漏、胆管狭窄、切口感染）等方面两组差异无统计学意义（P〉0．05）。学习曲线、手术时间甲组优于乙组，差异有统计学意义（P〈0．01）。结论严格掌握手术适应证，输尿管硬镜联合腹腔镜治疗胆管结石手术是一种微创、安全有效、简捷的手术方式，值得临床推广应用。必要时联合胆道镜探查取石可提高取石率。

Analysis of apply electronic choledochoscope and ureteroscopic in laparoscopic exploration of commonbile duct lithotomy

Objective Investigate the advantage of apply electronic choledochoscope and ureteroscopic in laparoseopic exploration of common bile duct lithotomy. Methods Finish the operation with routine 4 hole methods. Peritoneal cavity drainage tube and T-tube is also routine procedure.Expose and incision bile duct anterior wall longitudinally.A group （31 cases）： finish the operation with ureteroscopic, B group （30 eases） ：finish the operation with electronic choledochoseope. Assess all case with data showed in 3 months follow up and 1 year follow up through telephone or clinic. Observation indexs include operation time, the amount of intraoperative bleeding, frequency of postoperative analgesia, the recovery tittle of gastrointestinal function, hospital day, hospitalization expenses, operation complications （retained bile duct stones, bile duet injury, bile leakage, stenosis of bile duct, infection of incisional wound）, learning curve etc.Analyse the data with statistical methods. Results 2 cases of A group change to electronic choledochoscope. The difference between two groups, the amount of intraoperative bleeding, frequency of postoperative analgesia, the recovery time of gastrointestinal function, hospitalday,hospitalization expenses, operation complications （retained bile duct stones, bile duct injury, bile leakage, stenosis of bile duct, infection of incisional wound） have no statistical significance （P 〉 0.05）, operation time, learning curve have statistical significance （P 〈 0.01）. Conclusion With strict control of operation indications, apply of ureteroscopic in laparoscopic exploration of common bile duct lithotomy is a minimal invasive, safe and effective,simple methods that worth to popularized and app lied. On occasion innecessity, electronic choledochoscope can enhance the success rate of lithotomy.