腹腔镜联合输尿管镜治疗肝胆管结石的临床研究

Clinical study of combination of ureteroscopy and laparoscopic surgery in treatment of patients with cholelithiasis

目的探讨腹腔镜联合输尿管镜治疗肝胆管结石的临床价值。方法腹腔镜联合输尿管镜治疗肝胆管结石35例(微创组),开腹手术治疗肝胆管结石41例(开腹组)。回顾性分析2种手术方法的手术时间、术中出血量、胆石清除率、术后并发症、术后肠功能恢复时间、术后住院时间、"T"管拔除时间及住院费用等临床指标的差异。结果微创组中33例完全在输尿管镜联合腹腔镜下完成胆道取石,另2例因术中胆道和肝门部血管出血及胆管撕裂而中转开腹手术。微创组患者的术中出血量、术后并发症、术后肠功能恢复时间及术后住院时间等方面均优于开腹组,差异有统计学意义(P<0.05)。而微创组患者的手术时间和"T"管拔除时间整体较开腹组长,差异有统计学意义(P<0.05)。2组在住院费用和胆石清除率方面则差异无统计学意义(P>0.05)。结论对于泥沙样、单发或多发的肝外胆管(或肝内一级胆管)结石,应用腹腔镜联合输尿管镜治疗是可行的,且具有创伤小、术后康复快及并发症少等优点,是肝胆管结石的一种微创治疗方法。

Objective To evaluate the clinical value of ureteroscopy in laparoscopic surgery treating for cholelithiasis.Methods Ureteroscopy was used in laparoscopic surgery treating for cholelithiasis in 35 cases （group of minimally invasive）,in laparotomy in 41 cases （group of laparotomy）.Retrospectly analyzed the operation time,blood loss,gallstone removal rate,postoperative complications,postoperative bowl function recovery time,postoperative hospital stay length,＂T＂ tube removal time and hospital expense between the two groups.Results The gall-stones were removed by ureteroscopy in 33 cases in group of minimally invasive.and other 2 cases were transfered to perform laparotomy forcedly,which due to split of biliary duct and vascular hemorrhage of porta hepatics.Comparing with these two groups,group of minimally invasive had advantages in less blood loss,lower postoperative complications rate,and shorter postoperative bowl function recovery time and postoperative hospitalization time.The difference were statistically significant （P0.05）.The time of operation and patients carrying ＂T＂ tubes were longer in group of minimally invasive than in group of laparotomy.The differences were statistically significant （P0.05）.Hospital expense and gallstone removal rate had no significant differences in two groups（P 0.05）.Conclusion Treating for the muddy gallstone,and single or multiple gallstone in the extrahepatic bile duct （or primary intrahepatic bile duct）,the application of laparoscopy combined with ureteroscopy is feasible,having the advantage of less trauma,faster postoperative recovery and fewer complication rate.It is a minimally invasive method to treat hepatic and biliary stones.