腹腔镜联合胆道镜在基层医院胆总管结石治疗的经验总结

The experience of treatment of common bile stones in basic-level hospital through laparoscope combined with choledochoscope

目的探索腹腔镜联合胆道镜在基层医院胆总管结石治疗的经验。方法回顾性分析2014年12月~2016年10月收治的84例胆总管结石患者,按其治疗方式,分为开腹组和腔镜组,并将患者平均分为两组,统计两组患者的手术时间、治疗费用、总住院天数、进食时间以及术后住院时间,同时,对两组患者术后并发症发生率密切观察与准确记录,对统计结果进行比较。结果两组的平均手术时间分别为(138±24)、(116±27)min,腔镜组稍高于开腹组,(P<0.05)具有统计学意义,而开腹组的总住院天数、进食时间以及术后住院时间明显高于腔镜组,经过统计学分析显示,(P<0.05)具有统计学意义。通过比较两组的治疗费用,我们发现两组的治疗费用相当,(P>O.05)无统计学意义。腔镜组发生胆漏1例(1/42),术后残留结石2例(2/42),无切口感染,开腹组发生切口感染1例(1/42),无胆漏及残留结石,通过比较,差异无统计学意义(P>O.05)。结论腹腔镜联合胆道镜治疗胆总管结石具有创伤小、术后恢复快及住院时间短的优点,在基层医院值得推广,但应严格按照手术适应证并熟练掌握手术要点,才能有效防止并发症的发生。

Objective To explore the experience of treatment of common bile stones in basic-level hospital through laparo- scope combined with choledochoscope o Methods Retrospective analysis 84 patients with common bile stones between Dec 2014 and Oct 2016,the patients were equally divided with two groups by laparotomy or laparoscope, the follow data were compared ： operation time, cost of treatment , total hospitalization time postoperative dieting time and hospitalization time and close observation and accurate record of complication rate. Results The average operation time of the two groups were （ 138 ± 24 ）, （ 116 ± 27 ） min, the laparoscopic group was slightly higher than that of the open group （ P 〈 0.05 ） , the cost of treatment , total hospitalization time, postoperative dieting time and hospitalization time of laparotomy are significantly higher than that of laparoseope, By comparing the treatment costs of the two groups, we found that the treatment costs of laparotomy group almost equate with that of laparoscope group （P 〉 0. 05 ）. bile leakage of 1 cases （1/42） , postoperative residual stones of 2 cases （2/42） ,no wound infection occurred in laparoscope group, 1 cases of wound infection, no bile leakage and residual stones occurred in laparotomy group, no significant difference was observed in two groups（ P 〉 0.05 ）. Conculusion： Laparoscopy combined with choledochoscopy has the advantages of less trauma, faster postoperative recovery and shorter hospitalization time in treatment of bile duct stones and should be worthy of promotion in basic-level hospital, however,we should master the surgical indications and surgical significant points to avoid the occurrence of complication rate