可视取石钳与取石网篮在两镜联合微创保胆取石术中的对比研究  

Comparative Study of Visual Lithotomy Forceps and Lithotomy Basket in Laparoscopic and Choledochoscopic Minimally Invasive Gallbladder Preserving Lithotomy

作　　者：杨奕[1] 杨涛[1] 宋辉[2] 史文宗[3] 李高岩[1] YANG Yi;YANG Tao;SONG Hui;SHI Wenzong;LI Gaoyan(Department of General Durgery;Department of Hematopathology;Statistics Room,Qinhuangdao First Hospital,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院普外科,河北秦皇岛066000 [2]秦皇岛市第一医院血液内科,河北秦皇岛066000 [3]秦皇岛市第一医院统计室,河北秦皇岛066000

出　　处：《医学综述》2018年第11期2281-2284,共4页Medical Recapitulate

基　　金：秦皇岛市科学技术研究与发展计划项目(201501B052)

摘　　要：目的比较可视取石钳与取石网篮在两镜(腹腔镜、胆管镜)联合微创保胆取石术中的临床效果。方法选择2014年1月至2016年12月秦皇岛市第一医院收治的128例胆囊结石患者为研究对象,患者经评估均需采用经保胆取石手术治疗。上述患者按随机数字法分为可视取石钳组和取石网篮组,各64例。患者均行腹腔镜下经胆囊镜探查、保胆取石手术,术中取石钳组应用可视取石钳取石,取石网篮组应用取石网篮取石。比较两组患者的取石成功率、手术时间、术后复发率及手术并发症发生率。结果患者均顺利完成经两镜微创保胆取石手术。术中无并发症,无需要中转施行腹腔镜胆囊切除术的病例。取石钳组:64例患者均一次性取石成功(1次取石成功率100.0%),手术时间(52.7±13.4)min,术后无手术并发症,1年结石复发率为1.6%(1/64)。取石篮组:64例患者中58例为一次性取石成功,1次取石成功率为90.6%(58/64),手术时间(61.2±14.2)min,术后1例(1.6%)发热患者,经物理降温后2 d内体温降至正常,1年结石复发率为3.1%(2/64)。两组取石成功率、手术时间比较差异均有统计学意义(P<0.05)。结论两镜联合保胆取石手术治疗胆囊结石可获得良好的除石效果,其中采用可视取石钳取石的取石成功率高、手术时间短。Objective To compare the clinical effect of visual lithotomy forceps and lithotomy basket in laparoscopic and choledochoscopic minimally invasive gallbladder preserving lithotomy.Methods From Jan.2014 to Dec.2016,128 cases of cholecystolithiasis in Qinhuangdao First Hospital were selected as the research objects.All patients needed to undergo gallbladder preserving surgery.According to the random number table method,the patients were divided into a lithotomy forceps group（64 cases,using visual lithotomy forceps to take stones）,and a lithotomy basket group（64 cases,using lithotomy basket to take stones）.The success rate of stone extraction,average operative time,postoperative recurrence rate and incidence of operative complications were investigated.Results All patients successfully completed the the minimally invasive gallbladder preserving operations.During operation no complications occurred,and no case needed laparoscopic cholecystectomy.Lithotomy forceps group：all of the 64 cases achieved successful stone removal,and the one-time success rate of stone extraction was 100.0%,the average operative time was（52.7 ± 13.4） min,no surgical complications after the operation,and the 1-year recurrence rate was 1.6%（1/64）.Lithotomy basket group：of the 64 patients,58 achieved successful stone extraction,the one-time success rate of stone extraction was 90.6%（58/64）,the average operation time was（61.2 ± 14.2） min,1 case（1.6%） had fever after the operation,after physical cooling the body temperature dropped to normal within 2 days,and the 1-year recurrence rate was 3.1%（2/64）.The successful rates of stone extraction and the average operation time of the two groups had statistically significant differences（P 0.05）.Conclusion Laparoscopic and choledochoscopic gallbladder preserving lithotomy can obtain good effect of stone removal,and the operations with visual lithotomy forceps have higher successful stone removal rate and shorter operative time.

关 键 词：胆囊结石 腹腔镜 纤维胆管镜 可视取石钳 取石网篮 

分 类 号：R657.4[医药卫生—外科学]