腹腔镜下运用输尿管软镜行经胆囊管胆总管探查取石术的临床疗效分析  

Clinical efficacy analysis of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope

作　　者：成时保 胡伟 温崇煜 廖国良 张浩 支小康 邹盛林 郑兴棱 艾济远 Cheng Shibao;Hu Wei;Wen Chongyu;Liao Guoliang;Zhang Hao;Zhi Xiaokang;Zou Shenglin;Zheng Xingling;Ai Jiyuan(Department of Hepatobiliary Surgery,the Third Hospital of Nanchang,Nanchang 330009,China)

机构地区：[1]南昌市第三医院肝胆外科,南昌330009

出　　处：《中华肝胆外科杂志》2025年第2期92-95,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：江西省卫生健康委科技项目(202510724)。

摘　　要：目的分析腹腔镜下运用输尿管软镜行经胆囊管胆总管探查取石术的临床疗效。方法回顾性分析2021年9月至2024年11月南昌市第三医院肝胆外科收治的96例胆囊结石伴胆总管结石患者的临床资料,其中男性49例,女性47例,年龄(59.2±13.9)岁。96例患者依据手术方式分为两组:接受腹腔镜胆囊切除+输尿管软镜经胆囊管胆总管探查取石术的患者纳入输尿管软镜组(n=48);接受腹腔镜下胆囊切除+经胆总管切开探查+放置T管引流的患者纳入胆总管切开组(n=48)。比较两组患者的手术时间、术中出血量、术后肠道功能恢复时间、腹腔引流管拔出时间、术后住院时间及术后并发症等临床资料。结果与胆总管切开组相比,输尿管软镜组患者的手术时间[150(120,176)min比197(165,240)min]、术中出血量[20(10,30)ml比30(20,50)ml]、术后肠道功能恢复时间[2(1,2)d比3(2,4)d]、腹腔引流管拔出时间[6(4,7)d比7(6,8)d]和术后住院时间[8(6,9)d比16(13,17)d]均减少,差异均具有统计学意义(均P<0.05)。胆总管切开组术后并发症发生率10.4%(5/48)与输尿管软镜组的2.1%(1/48)相比,差异无统计学意义(χ^(2)=1.60,P=0.206)。结论与腹腔镜下胆总管切开取石+T管引流术相比,腹腔镜下运用输尿管软镜行经胆囊管胆总管探查取石术可缩短胆总管结石患者的住院治疗时间,是一种微创、安全、有效的治疗方法。Objective To analyze the clinical efficacy of laparoscopic common bile duct exploration and stone removal via the cystic duct with a flexible ureteroscope.Methods The clinical data of 96 patients with cholecystolithiasis and choledocholithiasis who were admitted to the Department of Hepatobiliary Surgery,the Third Hospital of Nanchang from September 2021 to November 2024 were retrospectively analyzed.There were 49 male and 47 female patients,aged(59.2±13.9)years.The 96 patients were randomly divided into two groups according to the surgical methods:the flexible ureteroscope group(n=48)and the choledochotomy group(n=48),patients who underwent laparoscopic cholecystectomy plus flexible ureteroscope for common bile duct exploration and stone removal via the cystic duct were included in the flexible ureteroscope group;patients who underwent laparoscopic cholecystectomy plus choledocholithotomy and T-tube drainage placement were included in the choledochotomy group.Clinical data including operation time,intraoperative blood loss,postoperative intestinal function recovery time,abdominal drainage tube removal time,postoperative hospital stay and postoperative complications were compared between the two groups.Results Compared with the choledochotomy group,the operation time[150(120,176)min vs.197(165,240)min],intraoperative blood loss[20(10,30)ml vs.30(20,50)ml],postoperative intestinal function recovery time[2(1,2)d vs.3(2,4)d],abdominal drainage tube removal time[6(4,7)d vs.7(6,8)d],and postoperative hospital stay[8(6,9)d vs.16(13,17)d]in the flexible ureteroscope group were all reduced,and the differences were statistically significant(all P<0.05).The incidence of postoperative complications in the choledochotomy group was 10.4%(5/48),compared with 2.1%(1/48)in the flexible ureteroscope group.There was no statistically significant difference(χ^(2)=1.60,P=0.206).Conclusion Compared with laparoscopic choledocholithotomy plus T-tube drainage,laparoscopic common bile duct exploration and stone removal via the cystic du

关 键 词：胆总管结石 腹腔镜胆总管探查 输尿管软镜 经胆囊管 

分 类 号：R65[医药卫生—外科学]