腹腔镜联合胆道镜、FREDDY激光治疗肝内胆管结石的临床体会  

Clinical experience of laparoscopy combined with choledochoscopy and FREDDY laser in the treatment of intrahepatic bile duct calculi

作　　者：张道建[1] 庄建民[1] 纪程宏[1] 颜松龄[1] 徐文军[1] 徐志鹏[1] 王华斌[1] 

机构地区：[1]厦门市第二医院海沧院区,福建厦门361026

出　　处：《腹腔镜外科杂志》2013年第3期192-195,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜联合胆道镜、FREDDY激光治疗肝内胆管结石的应用价值。方法:回顾分析104例肝内胆管结石患者的临床资料,分别行腹腔镜手术(腹腔镜组,n=57)及开腹手术(开腹组,n=47)。对比分析两组患者手术时间、术中出血量、术后肛门排气时间、切口感染率、严重并发症发生率(胆道大出血、严重胆漏等)、术后住院时间、一期结石清除率、总结石清除率等指标。结果:腹腔镜组术中出血量、术后肛门排气时间、切口感染率、一期结石清除率、术后住院时间均优于开腹组,差异有统计学意义(P<0.05)。两组手术时间、总结石清除率及严重并发症发生率差异无统计学意义(P>0.05)。结论:腹腔镜联合胆道镜、FREDDY激光碎石术治疗肝内胆管结石具有微创、安全、可靠、有效的优势,为肝内胆管结石提供了新的治疗方式,值得推广。Objective：To investigate the clinical efficacy and value of laparoscopy combined with choledochoscopy and FRED- DY laser in the treatment of intrahepatic bile duct calculi. Methods ：The clinical data of 104 patients with.tntrahepatie bile duct calculi were retrospectively analyzed. There were 57 cases in laparoscopic group and 47 cases in open group. Operative time, intraoperative blood-loss, time of first flatus, incidence of incision infection, severe complications （ e. g. biliary tract hemorrhage, serious bile leakage） , postoperative hospital stay, one-stage calculi clearance rate and overall rate of bile duct clearance were compared between 2 groups. Re- suits ： Laparoscopic group experienced less intraoperative blood-loss [ （51.2 ＋ 15.2） ml , earlier first flatus [ （ 22.2 ＋ 5.5 ） h ], lower incision infection rate （1.8%） ,higher one-stage calculi clearance rate （73.7%） and shorter hospital stay [ （6.1 ＋ 1.3） d]than those in open group [ （ 112.5 ＋- 26.7 ） ml, （ 32.6 ＋ 9.6 ） h, 12.8% ,55.3 %, （ 10.0 ＋ 2.3 ） d I （ P 〈 0.05 ）. There were no statistically significant differences in operative time, overall calculi clearance and incidence of severe complications between the two groups （ P 〉 0.05）. Conclusions： Laparoscopy combined with choledochoscopy and FREDDY laser is recommendable to treat intrahepatic bile duct calculi with the advantages of minimal invasiveness, safety, reliability and efficiency. This procedure provides a new treatment method for intrahcpatic bile duct calculi, and is worth popularization.

关 键 词：肝内胆管结石 腹腔镜检查 胆道镜检查 碎石术 激光 

分 类 号：R657.4[医药卫生—外科学]