纤维胆道镜取石在术中及术后的应用及选择

Intraoperation and postoperation application and selection of choledochofiberscope stone removal

目的术中、术后胆道镜取石已较为广泛应用,特别是近些年来结合腹腔镜行胆道探查取石。探讨胆道镜在术中及术后应用的合理性,以更好地指导胆道镜应用。方法 205例胆道结石患者,其中男性117例,女性88例;年龄21～82岁,平均年龄49.2岁。对其术中及术后行纤维胆道镜取石效果、取石花费时间和并发症等进行对比分析,并就20年来术中及术后胆道镜应用的趋势进行总结。结果肝内外胆管结石术中及术后胆道镜下取净率分别为88.5%、95.8%;肝内胆管结石取净率分别为63.6%、81.5%,但其差异均无统计学意义(P>0.05);术中及术后纤维胆道镜取石所用时间为(25.06±17.30)min和(20.14±14.50)min,差异亦无统计学意义(P>0.05);无论术中或术后胆道镜取石均未出现严重并发症;术中胆道镜取石的应用有逐年增加趋势,而术后胆道镜取石应用渐少,但在部分病例仍需术中、术后胆道镜结合使用以达到取净结石的目的。结论术中胆道镜取石与术后相比取石效果无显著差异,但可以降低术后残石率,且无严重并发症,对于患者病情许可、无需严格限制手术时间的病例均可应用,而术后胆道镜应用可以作为前者的补充,以达到取净结石的效果。

Objective To study the clinical application of choledochofiberscope in the treatment of bile duct diseases and its rationality.Methods A total of 205 patients with intraoperative or postoperative bile duct calculus removal performed choledochofiberscope were enrolled,male 117,female 88,aged 21-82 years,mean age 49.2 years.The effect of stone removal,time consumption,complication and application trend of choledochofiberscope were analyzed.Results The removal rate of operation in patients with calculus of extrahepatic and intrahepatic bile duct performed intraoperation and postoperation choledochofiberscope were 88.5 % and 95.8 %,respectively;while 63.6 % and 81.5 % in patients with calculus of intrahepatic bile duct applied with choledochofiberscope during intraoperation and postoperation,and no significant difference（P 0.05） was found.The average time consumption of operation in intraoperation and postoperation was（25.06 ± 17.30） minutes and（20.14 ± 14.50） minutes,respectively,also without significant difference（P 0.05）.There was no serious complication in all cases.The application trends of choledochofiberscope in intraoperation were increased,while decreased at postoperation.Some cases need to underwent choledochofiberscope both in intraoperation and postoperation.Conclusion It is demonstrated that the same effect of stone removal with choledochofiberscope in intraoperation and postoperation,which reduce the rate of postoperative residual stone rate and without serious complications.It could securely apply for patients with permissible conditions and without severe restriction on operation time.The choledochofiberscope at postoperation could be used as complement of intraoperation for removing calculus completely.