腹腔镜联合胆道镜治疗胆总管结石的疗效观察

Clinical observation of laparoscopy combined with choledochoscopy in the treatment of common bile duct stones

目的探讨腹腔镜联合胆道镜行胆总管探查取石术治疗胆总管结石的近远期疗效。方法选择深圳南山医院及江门市人民医院2014年7月至2015年7月收治的96例胆总管结石患者为研究对象,以随机数字表法分组,观察组48例,对照组48例,对照组行开腹胆囊切除术与胆总管切开取石术,观察组实施腹腔镜联合胆道镜行胆总管探查取石术治疗,观察术后近远期疗效。结果观察组手术时间、术后胃肠蠕动恢复时间、住院时间、医疗费用均低于对照组,差异有统计学意义(P<0.05);对照组术后感染、术后出血等并发症发生率明显较观察组高,差异有统计学意义(P<0.05);对照组术后1年复发率2.63%,观察组复发率为5.26%,两组差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜行胆总管探查取石术创伤小,可减少并发症发生率,利于术后恢复,也能取得与开腹手术相同效果,值得临床推广。

Objective To probe into the short - term and long - term clinical effects of laparoscopic common bile duct exploration under laparoscope combined with choledochoscope in the treatment of common bile duct stones. Methods Ninety-six cases of common bile duct stones who accepted treatments in Nanshan hospital of Shenzhen and the people＇s Hospital of Jiangmen from July 2014 to July 2015 were selected as the research objects, and were grouped by the random number table method, which the 48 cases in the observation group, 48 cases in the control group. In the control group were underwent open cholecystectomy and common bile duct incision while in the observation group were implemented the laparoscopic common bile duct exploration under laparoscope combined with choledochoscope. Then, the short and long-term clinical effects after operation were observed. Results Compared with the control group, the operation time, gastrointestinal peristalsis recovery time after operation, hospitalization time, medical expenses in the observation group were lower, the difference was statistically significant （P〈0.05）; The incidence of infection after operation, bleeding and other complications in the control group was significantly higher than that in the observation group, the difference was statistically significant （P〈0.05）; The recurrence rate after operation for 1 year in the control group was 2.63%, the recurrence rate in the observation group was 5.26%, and there was no significant difference between the two groups （P〉0.05）. Conclusion The laparoscopic common bile duct exploration under laparoscope combined with choledochoscope has small trauma, and can reduce the incidence of complications, it is conducive to recovery after operation, but also can achieve the same effect with open surgery, and thus it is worthy of clinical promotion.