纤维胆道镜下微创保胆手术综合治疗胆囊结石患者的疗效分析

Clinical efficacy of comprehensive treatment for the patients under- going choledochoscopic gallbladder-preserving operation

目的总结利用纤维胆道镜行微创保胆手术综合治疗胆囊结石的经验。方法用内镜微创保胆取石手术及内镜微创保胆取石术后服用利胆护胆中药，对183例胆囊结石患者进行了随机对照分组，观察下列指标：术中：手术时间、术中出血量、胆瘘和胆总管损伤；术后：反流性胃炎食管炎、胆总管结石发病率、患者的消化功能、胆囊结石的复发牢、胆囊壁的厚度、胆囊的收缩功能。结果单纯内镜微创保胆取石组结石复发率为7．7％（7／91），胆囊壁厚度为（3．5±0．6）mm，胆囊收缩功能为（34．0±3．6）％，内镜微创保胆取石加中药口服组结石复发率为1．1％（1／92），胆囊壁厚度为（2．5±0．5）mm，胆囊收缩功能为（48．0±4．5）％，上述两组对应值差异均有统计学意义（P〈0．01）。结论内镜微创保胆取石手术是一种安伞有效的微创治疗方法，术后加用中药护胆治疗，能够降低保胆取石手术后胆囊结石复发率。

Objective To investigate the effect of choledochoscopic gallbladder-preserving cholecystolithotomy combined with traditional Chinese medicine treatment. Methods A randomized controlled clinical study was con- ducted to analyze the 91 patients who were treated with choledochoscopie gallbladder-preserving cholecystolithotomy and 92 patients who underwent the same operation combined with subsequent treatment of traditional Chinese medi- cine. lntraoperative, postoperative and follow-up data were compared between the 2 groups （including operation time, blood loss, the rate of biliary fistula and common bile duct injm7 （luring the operation, gallbladder contraction function, the recurrence rate of gallstone, etc）. Results In the simple choledochoscopic gallbladder-preserving cholecystolithotomy group, rate of gallstone recurrence was 7.7% （7/91） , the gallbladder wall was （ 3. 5 ±0.6） mm, the gallbladder contraction function was （34.0 ± 3.6）%. However, the comprehensive treatment group, the rate of gallstone recurrence was 1.1% （1/92） , the gallbladder wall was（2.5± 0.5 ） mm, the gallblad- der contraction function was （48.0 ± 4.5 ）%. There were significant differences between the two groups respectively （P 〈 0.01, respectively）. Conclusion Choledochoscopic gallbladder-preserving cholecystolithotomy combined with traditional Chine＇s medicine treatment is a safe, feasible, and minimal invasive approach for gallstone, and it can be considered as a alternative treatment of gallstone.