腹腔镜联合胆道镜治疗胆总管结石与开腹手术的临床对比研究  

Effect Comparison on Common Bile(Hepatic) Duct Calculi Treatment between Laparoscopy Combined with Choledochoscopy and Open Surgery

作　　者：黄康泽 姚勇[1] 全勇[1] 唐明[1] 赵利[1] 易清平[1] 杜甫求 杨红亮[1] 

机构地区：[1]湖南省怀化市中医院微创外科,怀化418000

出　　处：《中国现代手术学杂志》2012年第6期421-424,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的比较腹腔镜联合胆道镜治疗胆(肝)总管结石与常规开腹手术的临床疗效。方法 2010年7月～2012年7月手术治疗胆(肝)总管结石患者92例,其中完全行腹腔镜联合胆道镜手术者49例(腹腔镜组),开腹手术治疗43例(开腹组),回顾性分析比较两组的临床疗效。结果 92例手术均获成功。两组手术时间、住院费用比较,无统计学差异(P>0.05),但腹腔镜组术中出血量、切口长度、术后下床活动恢复时间、肛门排气时间、住院时间及术后镇痛治疗率方面均明显优于开腹组(P﹤0.01)。腹腔镜组术后共发生并发症4例(8.2%),开腹组发生20例(46.5%),组间比较有显著性差异(P<0.01)。两组并发症均经换药、消炎、溶栓等治疗后痊愈。两组残留胆总管结石各1例,术后6周经胆道镜二次手术取出。结论腹腔镜联合胆道镜治疗胆(肝)总管结石具有术中出血少、下床活动时间早、术后肠道功能恢复快、住院时间短、无明显手术疤痕、术后并发症少等优点,体现了腹腔镜联合胆道镜治疗胆(肝)总管结石的优越性,值得推广。Objective To compare the treatment effect of common bile （hepatic） duct stones be- tween laparoscopy combined with choledochoscopy and conventional open surgery. Methods The clini- cal data of 92 patients suffered common bile （hepatic） duct stones admitted from July 2010 to July 2012 were analyzed retrospectively. Among them, 49 cases were treated by laparoscopy and choledochoscopy （ as laparoscopic group）, and the other 43 cases were treated by open surgery （ as open group）. Results The operations were successful in all the 92 cases. There was no statistic difference in operative duration and hospital cost between two groups （ P 〉 0.05 ） , but the intraoperative blood loss, the incision length, postoperative out-of-bed activity recovery time, gastrointestinal recovery time, hospital stay time and post- operative analgesia treatment rate was significantly better in laparoscopic group than those in open group （ P 〈 0.01 ）. Postoperative complication was found in 4 cases （8.2%） in laparoscopic group, and was obviously lower than 20 cases （46.5%） in open group （ P 〈 0.05 ）. Residual stones was found in one case in two groups respectively, and cleared by re-choledochoscopy 6 weeks after the operation. Conclusion The treatment of laparoscopy combined with choledochoscopy is an effective therapy for common bile（hepatic） duct stones with more advantages such as less blood loss, earlier out-of-bed activity, quickly recovery of postoperative gastrointestinal function, short hospital stay, minimally inci- sion and less postoperative complication, and it is worthy to be popularized.

关 键 词：腹腔镜检查 胆道镜检查 胆总管结石 胆道外科手术 

分 类 号：R657.42[医药卫生—外科学]