纤维胆道镜在胆道手术术中及手术后的应用

Intraoperation and Postoperation Application of Choledochofiberscope in Biliary Tract Surgery

目的:探讨纤维胆道镜在术中及术后的治疗效果。方法:185例胆道结石患者(其中160例为胆总管结石术后,25例为胆总管结石合并肝内胆管结石术后),其中男性81例,女性104例;年龄25～82岁,平均年龄49.7岁。比较术中及术后行纤维胆道镜取石效果、取石花费时间、术后残石率和术后并发症有无差异。结果:胆管结石术中及术后胆道镜下取净率分别为76.5%、91.9%,但其差异无统计学意义(P>0.05);术中及术后纤维胆道镜取石所用时间为(25.76±15.30)min和(21.31±13.72)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。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。并且胆道镜的应用可以减少再次开腹手术机率,降低手术的费用,具有安全性高、创伤小、费用低的优点。

Objective： To study the therapeutic effect of choledochofiberscope in the treatment of bile duct diseases. Methods：A total of 185 patients with intraoperative or postoperative bile duct calculus removal performed chole- dochofiberscope were enrolled（ 160 cases with common bile duct stones after operation,25 cases with both common bile duct stones and hepatolithiasis after aperation）, male 81, female 104, aged 25 - 82 years, mean age 49. 7 years. The effect of stone removal, time consumption, postoperative residual stone rate and complication were analyzed. Results： The removal rate of operation in patients with bile duct calculus performed intraoperation and postoperation choledochofiberscope were 76. 5% and 91.9%, respectively, whereas no significant difference （P 〉 0. 05） was found. The average time consumption of operation in intraoperatiou and postoperation was （25.76±15. 30） minutes and （21.31 ± 13.72） minutes, respectively, also without significant difference （P 〉 0. 05 ） . There was no serious complication in all cases. Concinsions：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 choledochofi- berscope at postoperation could be used as complement of intraoperation for removing calculus completely. choledochoscope applications can reduce the chance of laparotomy once again and the cost of surgery, with advantages such as highly safe, minimally invasive and low cost.