双镜联合经胆囊管胆总管探查取石术120例临床观察

Clinical observation on 120 cases of choledochotomy operation through double mirror combined with transcystic common bile duct exploration

目的观察双镜联合经胆囊管胆总管探查取石术的效果及操作技巧。方法将我院2013年3月至2015年6月120例采用双镜联合经胆囊管胆总管探查取石术的胆总管结石患者作为观察组,同期开腹胆囊切除胆总管探查术的76例胆总管结石患者作为对照组,比较两组手术成功率、平均手术时间、术中平均出血量、术后疼痛评分、平均住院时间及近、远期并发症。结果观察组术中平均手术时间短于对照组,平均出血量少于对照组,平均住院时间短于对照组,术后平均VAS评分低于对照组,差异有统计学意义（P〈0.05）。观察组111例经胆囊管胆总管探查取石术取出结石,7例患者腔镜下行胆总管切开取出结石,手术成功率98.33%;对照组76例手术均成功,成功率100%,差异无统计学意义（χ^2=1.108,P〉0.05）。两组近、远期并发症比较差异无统计学意义（P〉0.05）。结论双镜联合经胆囊管胆总管探查取石术可避免切开胆总管和T管引流,是安全、有效、微创的手术方式。

Objective To observe the effect and operation skill of double mirror combined with common bile duct exploration and stone removal. Methods From March 2013 to June 2015,120 cases with common bile duct stones with endoscopy combined with transcystic common bile duct exploration in our hospital as observation group and laparotomy gallbladder excision of common bile duct exploration（ LCDE） of 76 cases of common bile duct stones in patients with as the control group,compared two groups of operation success rate and average operative time,average amount of bleeding,postoperative pain score,average hospitalization time and short- and long-term complications. Results The average operation time in the observation group was shorter than that in the control group,the average bleeding amount was shorter than that in the control group,the average length of hospital stay was shorter than that in the control group,the average VAS score was lower than the control group,the difference was statistically significant（ P〈0. 05）. Observation group of 111 cases of transcystic duct exploration of common bile duct lithotomy,removed the stones,5 cases of patients underwent laparoscopic common bile duct exploration and removing the stone,surgical success rate of 98. 33%; control group（ 76 cases were successful,the success rate of 100%,the difference was not statistically significant（ χ-2= 1. 108,P〉0. 05）. There was no significant difference in the two groups（ P〈0. 05）. Conclusions Double mirror combined with transcystic common bile duct exploration can avoid incision drainage of common bile duct and T,is a safe and effective operation,minimally invasive surgery.