斑马导丝与胆道镜在腹腔镜胆总管探查术中的应用  

Application of Zebra Guidewire and Choledochoscopy in Laparoscopic Common Bile Duct Exploration

作　　者：陈金水[1] 张少炎[1] 张罕松[1] 王铁虎[1] 陈卫东[1] 杨松[1] 蔡晓棠[1] Chen Jinshui;Zhang Shaoyan;Zhang Hansong(Department of General Surgery, The No. All Hospital of PLA , Xiangyang 441003 , China)

机构地区：[1]解放军第477医院普外科,襄阳441003

出　　处：《中国微创外科杂志》2018年第3期236-240,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：2014年全军医学科技青年培育项目.孵化项目(14QNP121)

摘　　要：目的探讨斑马导丝与胆道镜在腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)处理胆囊结石合并胆总管结石的应用价值。方法回顾性分析2012年1月~2016年6月我院腹腔镜胆囊切除术(1aparoscopic cholecystectomy,LC)联合LCBDE治疗110例胆囊结石合并胆总管结石的临床资料,46例使用斑马导丝为观察组,64例未使用斑马导丝为对照组。比较2组手术时间、术中出血量、术后进食时间、中转开腹率、术后并发症、术后住院时间和住院费用等指标。结果 2组手术均获成功,无围手术期死亡。2组术中出血量、术后进食时间、住院费用无统计学差异(P>0.05)。观察组手术时间(132.9±34.4)min,明显短于对照组(153.4±50.4)min(t=2.379,P=0.019)。观察组中转开腹率10.9%(5/46),明显低于对照组31.2%(20/64)(χ2=6.330,P=0.012);观察组术后住院时间中位数9.0(8.0,11.0)d,明显短于对照组11.0(10.0,14.0)d(Z=-4.604,P=0.000)。观察组并发症发生率10.9%(5/46),与对照组15.6%(10/64)无统计学差异(χ2=0.514,P=0.473),其中观察组术后发生切口感染1例、胆漏2例、结石残留1例、休克1例,对照组术后发生切口感染4例、胆漏2例、结石残留2例、休克2例,2组共15例均经保守治疗痊愈。结论胆道镜联合腹腔镜手术治疗胆囊结石合并胆总管结石安全有效,术中使用斑马导丝可提高腹腔镜下胆道镜操作效率,缩短手术时间,降低中转开腹率,值得临床推广应用。Objective To evaluate the value of zebra guidewire and choledochoscopy in laparoscopic common bile duct exploration for gallbladder combined with common bile duct stones.Methods Clinical data of110patients who received laparoscopic cholecystectomy and laparoscopic common bile duct exploration for cholelithiasis and choledocholithiasis from January2012to June2016in our hospital were retrospectively analyzed.According to wether or not using the zebra guidewire during surgery,they were divided into two groups:the observation group(46cases)and control group(64cases).The operative time,intraoperative blood loss,laparotomy rate,postoperative complications,postoperative ambulation time,postoperative hospital stay and hospital costs were compared.Results The operation was successfully completed in all the110cases,without perioperative death.The intraoperative blood loss,postoperative diet time,and hospital costs had no significant differences between the two groups(P>0.05).The observation group had significantly shorter operation time(132.9±34.4min)than the control group[(153.4±50.4)min,t=2.379,P=0.019].There were5cases(10.9%,5/46)converted to open laparotomy in the observation group and20cases(31.2%,20/64)in the control group,with statistically significant difference(^2=6.330,P=0.012).The median postoperative hospital stay in the observation group was9.0d(8.0,11.0d)and in the control group was11.0d(10.0,14.0d),with significant difference(Z=-4.604,P=0.000).Differences in postoperative complications between the two groups was not statistically significant[10.9%(5/46)vs.15.6%(10/64),=0.514,P=0.473].In the observation group,there were1case of woundinfection,2cases of bile leakage,1case of residual stones,and1case of shock.In the control group,there were4cases of wound infection,2cases of bile leakage,2cases of residual stones,and2cases of shock.All of the15cases were cured by conservative treatment.Conclusions Choledochoscopy combined with laparoscopy in the treatment of cholelithiasis and choledocholithiasis is safe and

关 键 词：腹腔镜 胆道镜 斑马导丝 胆囊结石 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]