腹腔镜联合胆道镜胆总管探查取石术42例

目的总结腹腔镜下胆总管探查取石术的临床经验,探讨改进手术技巧、提高手术疗效的方法。方法将在2008年1月至2010年9月施行的腹腔镜下胆总管探查取石术42例患者作为Ⅰ组,同时选取近期42例开腹胆总管探查取石术患者作为Ⅱ组,对手术过程、手术并发症、术后恢复等情况进行回顾性对比分析。结果Ⅰ组平均手术时间（220±58）min,明显长于Ⅱ组（130±45）min（P〈0.05）。Ⅰ组术中出血量为（30±10）ml,Ⅱ组术中出血量为（75±21）ml（P〉0.05）。Ⅰ组术后下床时间及出院时间分别为（21.5±7.5）h和（7.5±2.5）d,明显短于Ⅱ组（49.7±14.3）h（P〈0.05）和（13.3±5.2）d（P〈0.05）。Ⅰ组术后胆瘘发生率为9.5%（4/42）,与Ⅱ组4.8%（2/42）无统计学差异（P〉0.05）。Ⅰ组结石残留率为19.0%（8/42）,与Ⅱ组14.3%（6/42）无统计学差异（P〉0.05）。结论腹腔镜联合胆道镜下胆总管探查取石术安全、可行,取石效果与开腹手术相当,创伤小、术后恢复快。

42 cases of laparoscopic common bile duct exploration

Objective To summarize the clinical experience of 42 cases of laparoscopic common bile duct exploration and explore the improvement of surgical techniques and operative effect.Methods 84 cases performed common bile duct exploration between January 2008 and September 2010 were divided into two groups：Group I included 42 cases underwent laparoscopic operation in da Vinci S system,Group II included 42 cases underwent open operation.Comparative study was carried out between these two groups.Results The operative Time of group I was longer than group II[（220±58）minites vs（130±45）minite,（P〈0.05）] while the blood loss in operation between group I and group II was no significant difference[（30±10）ml vs（45±21）ml,（P〈0.05）].The length of bed time and hospital stay post operation of group I were were shorter than group II[（21.5±7.5）hours vs（49.7±14.3）hours,（P〈0.05）;（7.5±3.2）days vs（13.3±5.3）days P〈0.05,respectively）].There was no significant difference of biliary fistula and residual stones rate between two groups（9.5% vs 4.8%,P〉0.05 and 19.0% vs 14.3%,P〉0.05）.Conclusion It is feasible and safe to do the operation of laparoscopic common bile duct exploration.Recovery is accelerated and blood loss was less.