新疆医科大学学报

目的探讨腹腔镜联合胆道镜对胆或肝总管结石患者围术期指标及残石率的影响。方法选取北京市和平里医院2014年9月-2016年6月收治的符合纳入标准的胆或肝总管结石患者100例。根据选取手术方法的不同,分为对照组(n=43)与试验组(n=57),分别采取常规开腹手术与腹腔镜联合胆道镜进行治疗。观察并比较两组患者的出血量、平均手术时间、肛门排气时间、下床时间、住院时间等指标;记录两组患者术后止痛药使用及并发症情况。结果试验组患者术中出血量[(24.19±8.49)mL]明显少于对照组[(92.17±15.36)mL](t=28.21,P<0.01),且试验组患者平均手术时间、肛门排气时间、下床时间、住院时间明显短于对照组,其差异均具有统计学意义(t=8.75、12.32、22.75、5.27,P均<0.01)。但两组患者住院费用差异无统计学意义(t=1.84,P=0.07>0.05)。试验组切口感染率、肺部感染率、止痛药使用率、胆漏发生率及残石率均低于对照组(χ²=8.67、6.32、7.68、119.77、16.44,P均<0.01)。结论腹腔镜联合胆道镜治疗胆或肝总管结石患者能够有效降低残石率及并发症的发生率,提高患者治疗及预后效果,值得临床推广。

Objective To investigate the effect of laparoscopy combined with choledochoscopy on perioperative and residual stone rates in patients with common bile(hepatic)duct calculi.Methods 100 patients were enrolled who were diagnosed with the common bile(hepatic)duct calculi in Beijing He Ping Li hospital from September 2014 to June 2016.According to the different methods of operation,the patients were divided into control group(n =43)and experimental group(n =57).The control group was treated with conventional laparotomy,while the experimental group was treated with laparoscopy combined with choledochoscopy,compared were the blood loss,the average operation time,anus exhaust time,bed time,length of hospitalization and other indicators of patients of the two groups;postoperative pain and complications of patients of the two groups were also observed.Results It was found that group intraoperatie blood loss(24.19±8.49)mL in experimental was significantly less than that of the control group(92.17±15.36)mL(t=28.21,P <0.01);and the average operation time,anus exhaust time,bed time,hospitalization time of experimental group was significantly shorter than that of the control group(t=8.75,12.32,22.75,5.27,P <0.01).But no statistically significant difference of the hospital cost was observed between the two groups(t=1.84,P =0.07>0.05).The incision infection,pulmonary infection,the incidence of complications such as bile leakage and the residual stone rate in experimental group were significantly lower than that of the control group(χ²=8.67,6.32,7.68,119.77,16.44,P <0.01).Conclusion Laparoscopy combined with choledochoscopy was shown to be effectively able to reduce the incidence of residual stone and the incidence of complications in the treatment of hepatic duct calculi,improving the treatment and prognosis,which is worthy of clinical application and popularization.