腹腔镜联合胆道镜保胆取石术同期治疗胆囊结石与胆总管结石的临床体会

目的:探讨为胆囊结石、胆总管结石患者行腹腔镜联合胆道镜保胆取石术的手术疗效及临床价值。方法:将68例患者按其意愿分为两组,观察组行腹腔镜联合胆道镜保胆取石术,对照组行传统胆囊切除胆总管切开取石术,比较两组手术时间、术中出血量、住院时间、并发症发生率及术后随访情况。结果:观察组中转开腹1例,对照组中转开腹2例,两组差异无统计学意义(P=0.648);两组手术时间差异无统计学意义(P>0.05);观察组术中出血量、住院时间优于对照组,差异有统计学意义(P<0.05);两组均未发生穿孔、出血、死亡等严重并发症,急性胰腺炎均为轻度,且经及时治疗后痊愈;急性胰腺炎、肺部感染、切口感染情况两组相比差异有统计学意义(P<0.05)。术后8周复查,均无结石复发及其他相关并发症发生,术后1年,对照组发现残余结石1例,经胆道镜取石后痊愈。结论:胆囊结石、胆总管结石患者行腹腔镜联合胆道镜保胆取石术后并发症少,患者痛苦轻,双镜联合可取长补短,优势结合,充分发挥微创的治疗原则。应根据患者的病情,制定个体化诊疗方案,以减少手术并发症,提高疗效。

Clinical study of laparoscopy combined with homochronous choledochoscopy in the treatment of cholecystolithiasis and chole- docholithiasis

Objective：To explore the therapeutic efficacy and clinical value of laparoscopy combined with choledochoscopy for cholecystolithiasis and choledocholithiasis. Methods： Sixty-eight patients were divided into 2 groups according to their wishes, the obser- vation group underwent laparoscopy combined with choledochoscopy, the control group underwent conventional cholecystectomy and cho- ledocholithotomy. Operation time, blood loss, hospital stay, complication and postoperative follow-up were compared between the two groups. Results：One case in the observation group and 2 cases in control group were converted to open cholecystectomy, there were no significant differences （P = 0.648 ） ; the operative time of two groups was not significantly different （P 〉 0.05 ） ; blood loss and the hos- pital stay in observation group were better than those of control group （P 〈 0.05） ; severe complications such as perforation, bleeding, death did not occur in two groups, acute pancreatitis was mild ,which was cured after timely treatment;there were statistically significant differences in acute pancreatitis,pulmonary infection and incision infection between the two groups （P 〈 0.05 ）. 8 weeks after opera- tion, there was not recurrence nor other complications. After 1 year, 1 case of residual calculi was found in the control group, and was re- moved by choledochoscope. Conclusions： Laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and chole- docholithiasis can reduce the incidence of postoperative complications and pain, draw on each other＇s strength, give full play to mini-in- vasive principle. Surgeons should make individualized diagnosis and treatment plan according to the patient＇s condition, in order to de- crease operative complications and increase surgical curative effect.