腹腔镜联合胆道镜在胆囊结石合并胆总管结石治疗中的应用

The Application Value of Laparoscope Combined with Choledochoscope in Treatment of Cholecystolithiasis Complicated with Choledocholithiasis

目的观察腹腔镜联合胆道镜手术治疗胆囊结石合并胆总管结石的临床效果。方法回顾性分析我院收治的85例胆囊结石合并胆总管结石的临床资料,根据手术方式不同将其分为观察组(41例)和对照组(44例),观察组采用腹腔镜联合胆道镜进行手术治疗,对照组采用传统开腹方法进行手术治疗,观察比较两组手术相关参数及术后并发症。结果观察组手术时间长于对照组,术中出血量、术后镇痛药物使用次数少于对照组,术后胃肠功能恢复时间及住院时间短于对照组,差异均具有统计学意义(P<0.05)。观察组术后发生胆漏3例、营养障碍2例、肺部感染2例,术后并发症发生率17.1%;对照组术后发生营养障碍9例、切口感染7例、肺部感染4例、胆漏2例、术后出血2例,术后并发症发生率54.5%。观察组术后并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜联合胆道镜手术治疗胆囊结石合并胆总管结石与传统开腹手术相比具有创伤小、术后并发症发生率低及术后恢复快等优点。

Objective To observe the clinical effect of laparoscope combined with choledochoscope in the treatment of cholecystolithiasis complicated with choledocholithiasis. Methods The clinical data of 85 patients with cholecystolithiasis comlicated with choledocholithiasis were retrospectively analyzed in our hospital,and according to different operation methods,they were divided into observation group（ n = 41） and control group（ n = 44）. The observation group received treatment by laparoscope combined with choledochoscope,and the control group received treatment with traditional open operation method,and the related parameters and postoperative complications were observed and compared between the two groups. Results Operating time of the observation group was longer than that of control group,and intraoperative blood loss,postoperative analgesia drug usage,postoperative gastrointestinal function recovery time and hospital stay were less and shorter than that of the control group,and the differences were statistically significant（ P〈0. 05）. In observation group,postoperative complications occurred in 3 cases of biliary leakage,2 cases of malnutrition,and 2 cases of pulmonary infection,the postoperative complication rate was 17. 1%; In control group,postoperative complications occurred in 9 cases of malnutrition,7 cases of wound infection,4 cases of pulmonary infection,2 cases of biliary leakage,2 cases of postoperative bleeding,and the postoperative complication rate was 54. 5%. The postoperative complication rate was significantly lower in the observation group than in the control group,and the difference was statistically significant（ P〈0. 05）. Conclusion Laparoscope combined with choledochoscope in the treatment of cholecystolithiasis with choledocholithiasis has such advantages as less trauma,lower complication rate and quicker postoperative recovery compared with traditional open surgical method.