胆囊结石合并胆总管结石术中两种胆总管探查取石方式的临床观察

目的探讨术中胆道镜经胆囊管途径行胆总管探查取石的可行性和优缺点,并与传统胆总管探查取石手术方式进行比较。方法对诊断为胆囊结石合并胆总管结石的79例接受开腹手术的患者、完成胆囊切除术后随机选择传统经胆总管切开取石+术中胆道镜探查取石+T管引流术(A组,n=40)或术中胆道镜经胆囊管途径行胆总管探查取石术(B组,n=39),观察治疗效果并进行随访。结果 B组的手术持续时间和术后住院时间均短于A组(P﹤0.001);术中出血量也少于A组(P﹤0.001);A组术后发生并发症4例,B组2例,2组无明显差别。结论术中胆道镜经胆囊管途径行胆总管探查取石术与传统的经胆总管前壁切开途径相比具有创伤小、病人术后恢复快的优点,手术安全,但需要严格掌握适应证。

Evaluation of two common bile duct exploration in patients with cholecystolithiasis and choledocholithlasis

OBJECTIVE To evaluate the clinical application of choledocholithotomy T-tube drainage combined with choledochoscope, and compare with the choledochoscope independently in open cholecystectomy. METHODS 79 patients with cholecystolithiasis and choledocholithiasis were divided into 2 groups through their operative ways. Group A included 40 patients, who were treated by choledocholithotomy T-tube drainage combined with choledochoscope in open cholecystectomy. Group B included 39 patients, who were treated by open choledocholithotomy combined with choledochoscope. We compared the 2 groups with operative time, blood loss, length of hospital stay and complications. RESULTS The operative time, blood loss and length of hospital stay in group B were less than those in group A (P﹤0.001). But there was no statistical difference in complications in those two groups (P﹥0.05). CONCLUSION Open cholecystectomy combined with choledochoscope was a safe, reliable and effective operative way, which had advantages of less trauma, quicker recovery and a shortened hospital stay under strict surgical indication.