腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的临床观察

Clinical effects of laparoscopy combined with duodenoscopy in the treatment of gallbladder stones complicated with common bile duct stones

目的 观察腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的效果.方法 104例胆囊结石合并胆总管结石患者照随机分为联合治疗组和对照组（各52例）,联合治疗组采用腹腔镜联合十二指肠镜治疗,对照组采用传统开腹手术.观察两组患者的手术情况、效果及并发症发生率.结果 联合治疗组术中出血量、住院时间及住院费用均少于对照组（P＜0.05）,两组患者手术时间差异无统计学意义（P＞0.05）;联合治疗组中2例患者因结石嵌顿转为开腹手术,取石成功率96.2％,对照组有1例因结石散落、嵌顿无法取出,取石成功率98.1％,两组患者取石成功率差异无统计学意义（P＞0.05）;联合治疗组无术后胆汁漏、切口裂开、出血和结石残留等并发症,对照组术后出现1例出血,1例结石残留.结论 腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石具有创伤小、疗效佳、并发症少等优点.

Objective To observe the clinical effects of laparoscopy combined with duodeuoscopy in the treatment of gallbladder stones complicated with common bile duet stones. Methods One hundred and four patients with gallbladder stones and choledocholithiasis in our department from January 2010 to April 2013 were randomly divided into two groups：the combination treatment group （n = 52）and the control group（n = 52）. Operation process,efficacy and complications in two groups were observed. Results The intraoperative bleeding, hospitalization time and costs in the combination treatment group were significantly lower than those in the control group （P 〈 O. 05 ） ;there was no significant difference in operation time be- tween the two groups（ P 〉 O. 05 ）. In the combination treatment group,2 cases were transferred to the open procedure because of the incarcerated stones and the rate of success was 96.2%. In the control group, only 1 ease had the scattered and incarcerated stones and the success rate was 98.1%. There were no signifi- cant differences in success rate between the groups （P 〉 0.05）. Conclusion In the treatment of gallblad- der stones complicated with common bile duet stones, laparoscopy combined with duodenoscopy is a proce- dure with minimal invasion, good clinical effects and few complications.