腹腔镜联合胆道镜治疗胆结石68例

Laparoscope combined with choledochoscope in the treatment of gallstones in 68 cases

目的探讨腹腔镜联合胆道镜治疗胆结石的疗效。方法将68例胆结石患者（包括胆囊结石和胆管结石）分为两组，腹腔镜联合胆道镜治疗组36例及传统开腹手术组32例，观察两组手术前后各项指标和术中并发症发生情况。结果腹腔镜和胆道镜组成功例数为31例，术后B超未见残余结石影，术中出血量（40．0±2．5）ml，手术时间（120±8）min，术后使用镇痛药者占12．9％，肠排气时间（11±4）h，切口感染率为3．2％，住院时间（6．1±1．3）d；开腹组术后4周后可见有2例有残余结石影，术中出血量（105．0±9．7）ml，手术时间（131±11）min，术后使用镇痛药者占83．9％，肠排气时间（23±6）h，切口感染率为25．8％，住院时间（15．3±3．4）d。两组手术时间比较差异无统计学意义，其他各项指标比较差异均有统计学意义（P〈0．05）。结论腹腔镜和胆道镜联合治疗胆结石在与传统开腹手术时间相似的基础上，有出血量少、创伤小、切口感染率低、患者术后恢复快等优点。

Objective To investigate the effect of laparoscope combined with choledochoscope on gallstones. Methods Sixty-eight gallstones patients （include cholecystolithiasis and hepatolithiasis） treated in department of hepatobiliary surgery of Xihua people＇ s hospital from 2009 to 2010, were divided into two groups, 36 cases in laparoscope combined with choledochoscope treatment group, 32 cases in traditional laparotomy surgery group, the indexes and intraoperative complications of the two groups before and after surgery were observed. Results Thirty-one cases achieved success in laparoscope combined with choledochoscope group, there was no residual stone shadow by B ultrasound after operation, the volume of intraoperative blood loss was（40. 0 ± 2. 5 ） ml, operating time was（ 120 ± 8 ） min, postoperative analgesics usage percentage was 12. 9%, intestines exhaust time was （11 ± 4）h, incision infection rate was 3.2%, hospital stay was（6. 1 ± 1.3 ） days. There was residual stone shadow in 2 cases of laparotomy surgery group 4 weeks after operation, the volume of intraoperative blood loss was （ 105.0 ± 9. 7 ） ml, operating time was （131 ± 11 ）min, postoperative analgesics usage percentage was 83.9%, intestines exhaust time was （23 ± 6 ）h, incision infection rate was 25.8%, hospital stay was （15.3 ± 3.4 ）days. There was no significant difference in operation time between the two groups, but there were significant differences in other indexes between the two groups （P 〈 0.05 ）. Conclusions Laparoscope combined with choledochoscope group is similar to traditional laparotomy surgery in operation time, but has the advantage of less blood loss, little trauma, small incision infection rate, quick postoperative recovery and so on.