腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用研究  

Clinical Application of Laparoscopic Combined with Choledochoscopy in the Treatment of Gallstones Complicated with Common Bile Duct Stones

作　　者：陈智敏[1] 汪昱[1] 徐建明[1] 李海[1] 赵盺波 Chen Zhimin;Wang Yu;Xu Jianming;Li Hai;Zhao Xinbo(Chongzhou People' s Hospital of Hepatobiliary Surgery, Chongzhou, Sichuan, 611230, China)

机构地区：[1]崇州市人民医院肝胆外科,四川崇州611230

出　　处：《当代医学》2019年第6期83-85,共3页Contemporary Medicine

摘　　要：目的分析不同手术方式治疗胆囊结石合并胆总管结石的临床应用效果。方法选取2014年1月至2016年1月崇州市人民医院肝胆外科收治的60例胆囊结石合并胆总管结石患者作为研究对象,患者知情同意后,随机分为开腹组和微创组,每组30例。开腹组患者采用开腹胆囊切除联合胆总管取石并T管引流治疗;微创组患者采用腹腔镜胆囊切除联合胆道镜胆总管探查并T管引流治疗,术后对比两组患者的结石清除率、复发率、手术相关情况和术后并发症等指标的情况。结果治疗后,微创组出现结石残余患者0例,开腹组出现结石残余患者4例;随访期间,微创组中有3例患者复发,开腹组中有5例患者复发。经卡方检验,微创组的残石率低于开腹组,差异具有统计学意义(P<0.05);两组复发率差别无统计学意义。与此同时,微创组的手术时间(127.33±23.84)min长于开腹组(114.52±25.12)min,两者差异具有统计学意义(P<0.05);此外,微创组术中出血量、肠鸣音恢复时间,肛门排气时间和总住院时间均少于开腹组,差异均具有统计学意义(P<0.05)。微创组术后并发症总发生率为26.67%;开腹组术后并发症总发生率为60.00%。经卡方检验,开腹组并发症总发生率高于微创组,差异具有统计学意义(P<0.05)。结论腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石具有术中出血少,患者恢复快,术后并发症发生率低的优点,值得在临床上推广应用。Objective To analyze the clinical application of different surgical methods in the treatment of gallstones complicated with common bile duct stones. Methods Sixty patients with gallstones and common bile duct stones admitted to the Department of Hepatobiliary Surgery, Chongzhou People' s Hospital from January 2014 to January 2016 were enrolled. The patients were randomly divided into open group and minimally invasive group and 30 cases each group. Patients in the open group were treated with open cholecystectomy combined with common bile duct stone removal and T tube drainage. Patients in the minimally invasive group were treated with laparoscopic cholecystectomy combined with choledochoscopy and T-tube drainage. The postoperative stone clearance rate was compared between the two groups, recurrence rate, surgical related conditions and postoperative complications. Results After treatment, 0 patients with residual stones in the minimally invasive group and 4 patients with residual stones in the open group. During the follow-up period, 3 patients in the minimally invasive group relapsed, and 5 patients in the open group relapsed. After chi-square test, the residual stone rate of the minimally invasive group was lower than that of the open group, and the difference was statistically significant (P<0.05). There was no significant difference in the recurrence rate between the two groups. At the same time, the operation time of the minimally invasive group (127.33±23.84) was longer than that of the open group (114.52±25.12), the difference was statistically significant (P< 0.05). In addition, the amount of bleeding and bowel in the minimally invasive group The time of sound recovery, anal exhaust time and total hospitalization time were lower than those of open group, and the difference was statistically significant (P<0.05). The total incidence of postoperative complications in the minimally invasive group was 26.67%;the total incidence of postoperative complications in the open group was 60.00%. After the chi-squar

关 键 词：腹腔镜 胆道镜 胆囊结石 胆总管结石 临床疗效 

分 类 号：R657.42[医药卫生—外科学]