腹腔镜联合输尿管硬镜在保胆取石术中的临床应用

The clinical application of ureteroscope in the laparoscopic cholecystolithotomy

目的:探讨腹腔镜联合输尿管硬镜行保胆取石术的可行性、优越性及手术技巧。方法:随机将2010年6月至2012年10月同一术者施行的60例微创保胆手术分为两组,30例行完全腹腔镜保胆取石术(对照组),30例行腹腔镜联合输尿管硬镜保胆取石术(观察组),对比分析两组患者手术时间、胃肠功能恢复时间、术中出血量、术后并发症等。结果:对照组中29例成功完成手术,1例因胆囊颈部结石嵌顿,钳夹取石失败,中转为胆囊切除术;观察组均成功完成保胆取石术。术后随访6～12个月,对照组复发1例,彩超、腹部CT检查提示胆总管结石;观察组无复发。两组均无术后胆漏、出血、胆囊癌发生。手术时间、术中出血量、胃肠功能恢复时间、复发率两组差异均有统计学意义(P<0.05)。结论:腹腔镜联合输尿管硬镜行保胆取石术安全、可行,具有明显的优越性,但操作技巧尚需深入研究。

Objective. To investigate the feasibility, superiority and surgical techniques of laparoscope-ureteroscope combination in the cholecystolithofomy. Methods ： Sixty cases undergoing minimally-invasive cholecystolithotomy by the same surgeon during Jun. 2010 and Oct. 2012 were randomly divided into two groups. 30 cases undergoing laparoscopic cholecystolithotomy were in the control group while the other 30 cases undergoing laparoscopic cholecystolithotomy combined with ureteroscope were in the observation group. The operation time, recovery time of gastrointestinal function, blood loss, postoperative complications were comparatively analyzed be- tween the two groups. Results：Twenty-nine operations were successful in the control group. 1 case was converted to laparotomy because gallstones incarcerated in the neck of gallbladder and removal of calculus failed. All the operations in the observation group were suc- cessful. Postoperative follow-up time was 6-12 months. 1 case recurred in the control group, CT and color Doppler ultrasound showed choledocholithiasis. No recurrence was found in the observation group. No bile leakage, bleeding or gallbladder carcinoma were observed after operations. The operation time, intraoperative blood loss, gastrointestinal function recovery time and postoperative recurrence be- tween two groups were significantly different （ P 〈 0.05 ）. Conclusions ： The laparoscopic cholecystolithotomy combined with uretero- scope is safe and feasible, and has obvious advantages. However, the operation skills remain to be further researched.