腹腔镜和胆道镜联合治疗复杂肝内外胆管结石  

Efficacy and safety of laparoscopy combined with choledochoscopy minimally invasive treatment on complicated intrahepatic and extrahepatic bile duct stones

作　　者：程柳[1] 邬涛[1] 王浩[1] CHENG Liu;WU Tao;WANG Hao(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院肝脏外科

出　　处：《肝胆外科杂志》2019年第3期171-174,共4页Journal of Hepatobiliary Surgery

摘　　要：目的分析腹腔镜和胆道镜联合微创治疗复杂肝内外胆管结石的疗效及安全性。方法选取2017年6月~2018年6月经本院诊治的72例复杂肝内外胆管结石患者,按手术方式不同分为观察组38例和对照组34例,观察组采取腹腔镜联合胆道镜取石,对照组行开腹取石,患者均进行6个月随访,比较两组手术相关一般情况、结石残留率及二次手术率、术后并发症、临床疗效及术后6个月结石复发率、生活质量[消化道相关生存质量量表(GIQLI)]。结果观察组手术时间、术中出血量、肛门排气时间、下床活动时间、住院时间均优于对照组(P<0.05);观察组结石残留率、二次手术率分别为2.63%、0.00%,均显著低于对照组的20.59%、14.71%(P<0.05);观察组术后并发症总发生率5.26%,显著低于对照组的26.47%(P<0.05);观察组疗效优良率97.37%,显著高于对照组的76.47%(P<0.05);术后6个月,两组结石复发率比较差异无统计学意义(P>0.05),观察组GIQLI得分显著高于对照组(P<0.05)。结论腹腔镜和胆道镜联合微创治疗复杂肝内外胆管结石疗效确切,术后恢复快、并发症少,值得临床应用。Objective To analyze the efficacy and safety of laparoscopy combined with choledochoscopy minimally invasive treatment on complicated intrahepatic and extrahepatic bile duct stones.Methods A total of 72 patients with complicated intrahepatic and extrahepatic bile duct stones who were diagnosed and treated in the hospital from June 2017 to June 2018 were selected.According to different surgical methods,the patients were divided into observation group (38 cases) and control group (34 cases).Observation group was given laparoscopy combined with choledochoscopy for lithotomy,and control group was given laparotomy for lithotomy,and all patients were followed up for 6 months.The general surgical conditions,stone residual rate and secondary operation rate,postoperative complications,clinical efficacy and stone recurrence rate at 6 months after operation and quality of life [Gastrointestinal Quality of Life Index (GIQLI)]were compared between the two groups.Results The operative time,intraoperative blood loss,anal exhaust time,ambulation time and hospital stay in observation group were better than those in control group (P < 0.05).The stone residual rate and secondary operation rate with 2.63% and 0.00% in observation group were significantly lower than those in control group with 20.59% and 14.71%(P < 0.05).The total incidence rate of postoperative complications in observation group was significantly lower than that in control group (5.26% vs 26.47%)(P < 0.05).The excellent and good rate of efficacy in observation group was significantly higher than that in control group (97.37% vs 76.47%)(P < 0.05).At 6 months after operation,there was no significant difference in the stone recurrence rate between the two groups (P > 0.05),and the GIQLI score in observation group was significantly higher than that in control group (P < 0.05).Conclusion Laparoscopy combined with choledochoscopy minimally invasive treatment has exact efficacy,quick postoperative recovery and few complications in the treatment of complicated intrahepatic

关 键 词：复杂肝内外胆管结石 腹腔镜 胆道镜 微创 疗效 安全性 

分 类 号：R657.4[医药卫生—外科学]