经胆囊管腹腔镜联合胆道镜胆道探查术应用研究(附80例报告)

Clinic study of bile duct exploration through cystic duct by laparoscope combined with choledochoscope(with 80 cases review)

目的探讨经胆囊管腹腔镜胆道探查术的临床应用。方法病人分成两组,A组:80例胆囊结石合并胆道继发结石病人,经胆囊管腹腔镜胆道探查术(胆囊管探查组),术后不用T管引流。B组:35例胆囊结石合并胆道继发结石病人,行开腹胆囊切除胆管探查T管引流术。观察手术时间、手术出血量、腹腔引流量、术后并发症、住院时间、肝功能及淀粉酶的变化。结果手术时间:胆囊管组和对照组分别为(168±34)min和(108±11)min,手术出血量为(50±8)mL和(321±53)mL。术后腹腔引流量为(30±17)mL和(104±33)mL,术后住院时间为(7.0±1.2)d和(18.2±2.0)d;术后并发症胆囊管探查组明显少于对照组,两组比较差异有显著性(P<0.001t,检验)。术后第1天谷丙转氨酶有轻微增高,3d后恢复正常,淀粉酶无明显变化。结论经胆囊管腹腔镜胆道探查术治疗继发性胆道结石和部分肝胆管结石是一种简单、可行和安全的微创新方法。

[Objective] To study the clinic application of bile duct exploration through the cystic duct by laparoscope combined with choledochoscope. [Methods] The patients were divieded into two groups. A group： 80 cases of cholecysthiasis coexisted with common bile duct stones were treated through the cystic duct by laparoscope combined with choledochoscope, without T tube drainage postoperation, B group： 35 cases were cured by openning the bile common duct with T tube drainage. We observed the duration time of the operation. The amount of bleeding during the operation, The amount of the abdomen drainage, complications, duration of the hospitalization and the variation of the liver function and amylase in the serium. [Results] The duration of the operation were （168±34） rnin in A group and （108±11） rain in B group. The amount of bleeding during the operation were 50±8 ml and （321±53） mL in Group A and B. The amount of the abdomen drainage in 3 days postoperafion were （30±17） mL and （104±33） mL, the duration of the hospitalization were （7±1.2） days and （18.2±2） days in Group A and B （P 〈0.001, t test）. The complications of operation was lower in Group A than in Group B; ALT went to normal in 3 days; amylase was no significant changes after operation. [Conclusions] The bile duet exploration through the cystic duct by laparoseope combined with choledochoscope without T tube drainage postoperation was a easy, practical and safe way to deal with bile duet stones.