FREDDY激光碎石术在腹腔镜联合胆道镜治疗难取性中央型胆管结石中的临床疗效评价  

Clinical efficacy of laparoscopy combined with cholangioscopic FREDDY laser lithotripsy for the treatment of difficult central type bile duct calculi

作　　者：颜松龄[1] 庄建民[1] 纪程宏[1] 张道建[1] 郭久冰[1] 潘梓荣[1] 

机构地区：[1]厦门市第二医院普外科,361021

出　　处：《中国医师进修杂志》2012年第23期26-29,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨FREDDY激光碎石术在腹腔镜联合胆道镜治疗难取性中央型胆管结石中的I临床疗效。方法腹腔镜联合胆道镜治疗难取性中央型胆管结石55例患者，根据治疗方法不同分为两组，FREDDY组31例，常规组24例。比较两组的手术时间、术中出血量、中转开腹率、术后肛门排气时间、术后严重并发症发生率（如胰腺炎、胆道出血、胆漏）、术后住院时间、一期结石清除率等指标。结果FREDDY组的手术时间、术中出血量、术后肛门排气时间、术后住院时间分别为（106．2±49.4）min、（37．7±28．6）ml、（25．8±19．3）h、（5．9±3．3）d，与常规组的（142．2±64．8）min、（60．3±32．1）ml、（37．2±21．6）h、（8．4±4．9）d比较差异有统计学意义（P〈0．05或〈0．01）；两组中转开腹率、术后严重并发症发生率、一期结石清除率比较差异无统计学意义（P〉0．05）。两组均无死亡病例，术后胆管残留结石7例患者均于术后6周经T管窦道行胆道镜取石术而治愈。43例患者术后随访6～12个月，未发现结石复发、胆管狭窄。结论腹腔镜联合胆道镜FREDDY激光碎石术治疗难取性中央型胆管结石具有微创、安全、高效、并发症少的特点，近期疗效佳。Objective To investigate the clinical efficacy of laparoscopy combined with cholangioscopic FREDDY laser lithotripsy for the treatment of difficult central type bile duet calculi. Methods Fifty-five patients with difficult central type bile duet calculi undergoing laparoscopy combined with cholangioscopy were analyzed retrospectively. There were 31 patients in FREDDY laser lithotripsy group （FREDDY group） and 24 patients in routine instrument group （routine group）. Operative time, intraoperative blood loss, conversion rate, time to first flatus, incidence of postoperative complications （ such as pancmatitis, hemobilia and biliary leak）, postoperative hospital stay and first session bile duct clearance rate were compared. Results Operative time, intraoperative blood loss, time to first flatus, postoperative hospital stay in FREDDY group [ （ 106.2 ± 49.4） min, （37.7 ± 28.6） ml, （25.8 ＋ 19.3 ） h, （5.9 ± 3.3 ） d ] were significantly lower than those in routine group[ （ 142.2 ± 64.8） min, （60.3 ＋ 32.1 ） ml, （37.2 ＋ 21.6） h, （8.4 ± 4.9） d] （P 〈 0.05 or 〈 0.01 ）. There were no statistically significant differences in conversion rate, incidence of postoperative complications and first session bile duct clearance rate between the two groups （P 〉 0.05 ）. There were no dead in both groups. Seven patients with residual bile duct stones were cured by cholangioscopy through T-tube sinus 6 weeks after prior surgery. Forty-three patients were followed up 6 to 12 months with no recurrent bile duct stones and bile duct stenosis. Conclusions Laparoscopy combined with cholangioscopic FREDDY laser lithotripsy is recommendable to treating difficult central type bile duct calculi with good short-term results and has the advantages of minimal invasiveness, safety, efficiency and rare complications.

关 键 词：腹腔镜 胆道镜 碎石术 激光 胆结石 

分 类 号：R657.4[医药卫生—外科学]