腹腔镜胆道镜联合钬激光治疗难取性胆管结石的临床效果观察  

Clinical Effect of Laparoscopic Choledochoscopy Combined with Holmium Laser in the Treatment of Refractory Bile Duct Stones

作　　者：汪启乐 冯伟 林斌 WANG Qi-le;FENG Wei;LIN Bin(Hepatobiliary and Pancreatic Surgery,Suqian Hospital of Xuzhou Medical University,Suqian,Jiangsu,223800,China)

机构地区：[1]徐州医科大学附属宿迁医院肝胆胰外科,江苏宿迁223800

出　　处：《黑龙江医学》2020年第10期1367-1369,共3页Heilongjiang Medical Journal

摘　　要：目的探究腹腔镜胆道镜联合钬激光治疗难取性胆管结石的临床效果,为治疗难取性胆管结石寻求最佳的治疗方案。方法选取2013年6月~2019年6月徐州医科大学附属宿迁医院收治的50例难取性胆管结石患者随机分为2组,各25例,分别行单纯腹腔镜胆道镜联合手术治疗和腹腔镜胆道镜联合钬激光治疗,观察对比两组患者手术时间、术中出血量、住院时间、首次排气时间、术后CRP及PCT值、中转开腹率、结石复发率、术后应激反应及并发症发生率等指标。结果观察组平均术中出血量及住院时间分别为(63.87±12.77)ml、(7.34±1.67)d较对照组略有减少,但差异无统计学意义,手术时间平均(93.82±29.53)min、首次排气时间平均为术后第(1.93±0.52)天,术后1、3 d的CRP值分别为(26.19±12.33)、(15.56±5.99)mg/L,PCT值(3.89±1.88)、(1.78±1.65)μg/L,P<0.05,较对照组差异有统计学意义。观察组未出现中转开腹和结石复发,术后发生应激反应及并发症各1例,中转开腹率、结石复发率、应激反应发生率及并发症发生率均低于对照组,P<0.05,较对照组差异有统计学意义。结论腹腔镜胆道镜联合钬激光治疗难取性胆管结石创伤小、恢复快、取石彻底、并发症少,值得在临床上推广应用。Objective To investigate the clinical effect of laparoscopic choledochoscopy combined with holmium laser in the treatment of refractory bile duct stones,and to seek the best treatment plan for the treatment of refractory bile duct stones.Methods 50 bile duct calculi patients in the hospital from June,2013 to June,2019 were randomly divided into 2 groups,with 25 cases in each group.Control group received line pure laparoscopic choledochoscope joint surgery,and observation group laparoscopic joint choledochoscope holmium laser treatment.Operation time,intraoperative blood loss,hospital stay,exhaust time,postoperative CRP and PCT values for the first time,transit operation rate,recurrence rate,emergency response and the incidence of complications such as postoperative indicators of two groups were observed and compared.Results The mean intraoperative blood loss and length of stay in the observation group were(63.87±12.77)ml and(7.34±1.67)d,respectively,which were slightly decreased compared with the control group.The difference was not statistically significant.PCT values(3.89±1.88)and(1.78±1.65)were significantly higher than those of the control group(P<0.05).In the observation group,there was no recurrence of transabdominal operation or calculi,and 1 case of emergency response and complications occurred after the operation.The rate of transabdominal operation,the recurrence rate of calculi,the incidence of emergency response and the incidence of complications were all lower than those of the control group(P<0.05).There was statistically significant difference.Conclusion Laparoscopic choledochoscopy combined with holmium laser in the treatment of refractory bile duct calculi has the advantages of less trauma,faster recovery,and complete stone extraction and fewer complications.So it is worthy of clinical application.

关 键 词：腹腔镜 胆道镜 钬激光 难取性胆管结石 临床效果 

分 类 号：R375.7[医药卫生—病原生物学]