腹腔镜联合胆道镜术治疗胆总管结石临床分析

Clinical analysis of laparoscope combined with choledochoscope surgery for choledocholithiasis

目的探讨腹腔镜联合胆道镜治疗胆总管结石的可行性及临床体会。方法回顾性分析2001年9月～2009年4月在柳州市工人医院行腹腔镜胆总管探查术(LCBDE)和开腹取石手术患者400例的临床资料,将患者分为腹腔镜组(273例)和开腹组(127例),对两组手术成功率、手术时间、术中失血量、肠功能恢复时间、住院时间、术后胆漏例数及残石例数等指标进行分析。结果腹腔镜组中7例中转开腹;术后出现胆漏2例,其中1例在术后4周拔除T管出现胆漏性腹膜炎;273例均痊愈出院,无术后腹腔严重感染、出血并发症发生。术后2个月通过胆道镜复诊、探察,发现残石27例,并通过胆道镜取尽结石。开腹组中所有患者手术均成功,术后出现胆漏6例,未出现胆漏性腹膜炎,均痊愈出院。两组的手术成功率和手术时间比较无明显差异,而腹腔镜组术中出血量、术后住院时间、肠功能恢复时间、胆漏例数及残石发生例数均明显低于开腹组(P<0.05)。结论腹腔镜联合纤维胆道镜治疗胆总管结石,提高了结石取出率和取净率,具有微创、疗效好、并发症少等优点,只要经过系统的腹腔镜手术训练就能掌握,并确保手术的安全,值得临床推广应用。

Objective To investigate the feasibility and clinical experience of laparoscope combined with choledocho- scope surgery in treating choledocholithiasis. Methods The clinical data of 400 patients who received laparoscopic common bile duct exploration （LCBDE） and laparotomy for biliary stones in Worker＇s Hospital of Liuzhou City from September i001 to April 2009 were retrospectively analyzed. The patients were divided into laparoscope group （273 cases） and laparotomy group （127 cases）. The achievement ratio of operation, operative time, intraoperative blood loss, recovery time of bowel function, case number of postoperative biliary fistula, and number of residual stones of patients in two groups were analyzed. Results In laparoscope group, there were 7 cases converted to laparotomy, 2 cases of postoperative bile leakage including one case of peritonitis caused by bile leakage after removal of T tube four weeks after operation, 273 cases were all cured and discharged, without postoperative severe abdominal infection and bleed- ing complications. Two months after operation, 27 residual stones were found by further choledochoscope inspection and clearly removed by choledochoscope. In laparotomy group, all patients were successfully treated by operation, there were 6 cases of postoperative bile leakage, no peritonitis caused by bile leakage, and all of them were cured and discharged. There was no significant difference in successful rate of operation and operative time between two groups. The intraoperative bleeding, postoperative hospital stays, postoperative recovery time of bowel function, case number of bile leakage, and number of residual stones of laparoscope group were significantly less or lower than these of laparo- tomy group （P 〈 0.05）. Conclusion In treating choledocholithiasis, laparoscope combined with choledochoscope surgery can improve the rate of stone removal and clearing out, has advantages of minimally invasive, good efficacy, and fewer complications. This method can be mastered through systemic training of laparoscopic surgery, can ensure the safety of operation, and it is worthy of wide clinical application.