两镜联合下胆总管探查取石治疗策略的临床研究

Clinical study of the treatment strategy of choledochoscopic combined with laparoscopic common bile duct exploration and lithotomy

目的:探讨腹腔镜联合胆道镜行胆总管探查取石的治疗策略、手术方法及临床效果。方法:回顾分析2010年6月至2014年7月行两镜联合胆道探查的150例临床资料。根据术前影像学检查,其中47例行腹腔镜经胆囊管胆道探查术治疗(LTCBD组);79例行腹腔镜胆总管切开+T管引流治疗(LD+TD组);24例行LD+I期缝合术(PS)治疗(LD+PS组)。对比分析各组手术时间、术中出血量、探查阴性率、T管留置率、住院时间、术后短期并发症等指标。结果:各组间平均手术时间、术中出血、术后并发症发生率比较,差异无统计学意义(P>0.05)。LTCBD组术后住院时间较短,明显短于其他2组(P<0.05),LTCBD组置管率及阴性置管率低于LD+TD组(P<0.05)。结论:对于需胆道探查的病人结合术前影像诊断与术中探查情况,综合运用基于胆囊管胆道探查(LTCBD)的治疗策略可以获得更好的临床效果。

Objective： To investigate the therapeutic strategies,surgical procedure,effect and experience of choledochoscopy combined with laparoscopic common bile duct exploration and lithotomy. Methods：From June 2010 to July 2014,150 patients under-went choledochoscopy combined with laparoscopic common bile duct exploration and lithotomy. Based on preoperative imaging examina-tion,47 patients scheduled for choledochoscopy combined with laparoscopic common bile duct exploration and lithotomy through cystic duct （ LTCBD group）;79 patients underwent laparoscopic common bile duct incision and T tube drainage treatment （ LD＋TD group）;21 patients underwent laparoscopic common bile duct incision and primary suture of common bile duct （ LD＋PS group） . Difference in operation time,intraoperative blood loss,negative rate of exploration,T tube indwelling rate,hospital stay,postoperative complications was compared between three groups. Results：Statistically,there was no significant difference in operation time,intraoperative blood loss and negative rate of exploration between the three group （P〉0. 05）. The hospital stay of LTCBD group was significantly shorter than the other two groups（P〈0. 05）. The negative rate of exploration and T tube indwelling rate is lower than LD＋TD group（P〈0. 05）. Conclusion：We can get better clinical results based on the integrated use of laparoscopic common bile duct exploration and lithotomy through cystic duct,based on preoperative diagnostic imaging and condition of intraoperative exploration.