腹腔镜与胆道镜联合取石术治疗肝内胆管结石的临床研究

目的:探讨腹腔镜联合胆道镜治疗肝内胆管结石的临床价值。方法:随机将80例肝内胆管结石患者分为2组,实验组(n=45)行腹腔镜联合胆道镜取石术,对照组(n=35)行单纯腹腔镜手术。结果:实验组45例手术均获成功,手术时间110～118 min,平均(160±15)min;术中出血量45～280 ml,平均(140±60)ml;住院6～8天,平均(7±2)天;42例结石完全取净,结石清除率93.3%,术后无一例发生胆漏、出血、脓肿等并发症。对照组手术时间130～220 min,平均(150±30)min;术中出血量80～350 ml,平均(180±75)ml;住院8～12天,平均(9±1)天;32例结石完全取净,结石清除率91.4%,术后2例发生胆漏。两组患者手术时间、术中出血量、住院时间差异有统计学意义(P<0.05),结石完全取净率及并发症发生率差异无统计学意义(P>0.05)。术后随访所有患者3～6个月,经胆道镜复查无一例复发。结论:腹腔镜术中联合胆道镜治疗肝内胆管结石安全有效,值得推广应用。

Clinical study of patients with hepatolithiasis treated with laparoscopic combined with choledochoscopic lithotomy

Objective:To investigate the clinical significance of hepatolithiasis treated with laparoscopic combined with choledochoscopic lithotomy.Methods:Eighty patients with hepatolithiasis were divided into 2 groups randomly.The experimental group included 45 patients and received laparoscopic combined with choledochoscopic lithotomy,and the control group included 35 patients and only received laparoscopic lithotomy.Results:All patients were operated successfully.The operation time of the experimental group was significantly longer than that of the control group(P<0.05).There was no significant difference in calculi clearance rate between the experimental group and the control group(P>0.05).The intraoperative blood loss of the experimental group was significantly less than that of the control group(P<0.05).No postoperative complications such as bile leakage,bleeding,abscess were found in the experimental group,but there were 2 patients who suffered from bile leakage in the control group.The total hospital stay of the experimental group was significantly less than that of the control group(P<0.05).All patients were followed up for 3 to 6 months,and reexamined by choledochoscope,and there was no recurrence.Conclusions:Laparoscopic combined with choledochoscopic lithotomy is an effective method for patients with hepatolithiasis,and deserves to be recommended in the clinical application.