腹腔镜联合胆道镜治疗肝胆管结石

TREATMENT FOR BILE DUCT STONES BY LAPAROSCOPY COMBINED WITH CHOLEDOCHOSCOPY

目的 :探讨腹腔镜联合胆道镜治疗肝胆管结石的临床价值。方法 :采取腹腔镜下胆总管切开、胆道镜探查取石、一期缝合胆总管或T管引流、术后胆道镜取石手术方法治疗肝胆管结石病人 70例 ,并与 70例开腹手术进行比较。结果 :35例手术均获成功 ,无中转开腹及严重并发症 ,手术时间与开腹手术相当 (P >0 .0 5 ) ;术后住院时间较开腹手术组明显缩短 (P <0 .0 5 ) ,病人痛苦轻 ,恢复快 ,部分病例随访半年以上未见远期并发症。结论 :腹腔镜联合胆道镜治疗肝胆管结石安全可靠 ,疗效满意 ,该术式可代替部分开腹手术。

Objective:To study the clinical value of laparoscopy combined with choledochoscopy for the treatment of bile duct stones.Methods:70 patients with bile duct stones underwent the procedure of laparoscopy bile duct exploration followed with intraoperative or postoperative choledochoscopy to clear stones and compared with 240 patients treated by traditional operative bile duct exploration.Results:35 patients had completed the procedure successfully without severe complications , and without converting to open choledocholithototomy. The time staying in hospital after operation is obviously less than that of open choledocholithototomy ( P <0.05). There was no significant difference in operative time between the two groups ( P >0.05). The patients recovered soon with less pain.Some patients who followed up on for half a year had no long-term complications.Conclusions:The technique of laparoscopy combined with choledochoscopy for the treatment of bile duct stones is safe, effective and minimal invasive. It can substitute some open choledocholithotomy.