腹腔镜联合胆道镜治疗复发性肝内外胆管结石的疗效与安全性观察

Efficacy and safety of laparoscopy combined with choledochoscopy in treatment of recurrent intrahepatic and extrahepatic bile duct stones

目的:观察腹腔镜联合胆道镜治疗复发性肝内外胆管结石的疗效与安全性。方法:回顾性分析78例复发性肝内外胆管结石患者的临床资料,将实施开腹手术治疗的39例患者设为对照组,将行腹腔镜联合胆道镜手术的39例患者设为观察组。对比两组患者的临床疗效和安全性。结果:观察组患者的住院时间为(6.32±1.51)d、肛门排气时间为(29.01±3.17)h、术中出血量为(42.43±29.64)ml、术后血色素下降(1.46±0.51)g/L,低于对照组的住院时间(13.87±1.26)d、肛门排气时间(63.82±4.37)h、术中出血量(151.46±32.51)ml、术后血色素下降(2.83±1.57)g/L,差异有显著统计学意义(P<0.01);观察组患者的术后并发症发生率为12.82%,远低于对照组的33.33%,差异有统计学意义(P<0.05);两组随访结果比较,观察组结石复发、胆管狭窄及胆管炎的总发生率为7.69%,远低于对照组的35.90%,差异具有显著统计学意义(P<0.01)。结论:腹腔镜联合胆道镜治疗复发性肝内外胆管结石的疗效与安全性优于开腹手术治疗疗效与安全性。

Objective:To observe efficacy and safety of laparoscopy combined with choledochoscopy in treatment of recurrent intrahepatic and extrahepatic bile duct stones.Methods:The clinical data of 78 patients with intrahepatic and extrahepatic bile duct stones were retrospectively analyzed.39 cases of open surgery were set as control group,while 39 cases of laparoscopy combined with choledochoscopy were set as observation group.The clinical efficacies and safety of the two groups were compared.Results:The hospitalization time(6.32±1.51) d,anal exhaust time(29.01± 3.17) h,intraoperative blood loss(2.43± 29.64) mL and hemoglobin reduction(1.46±0.51) g/L in the observation group were significantly lower than those of the control group of(13.87±1.26) d,(63.82±4.37) h,(151.46±32.51) mL and(2.83±1.57) g/L,and the differences were statistically significant(P<0.05).The incidence of postoperative complications(12.82%) in the observation group was lower than that in the control group(33.33%),and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of biliary stricture,cholangitis and recurrent bile duct stones(7.69%) in the observation group was better than that in the control group(35.90%),and the difference was statistically significant(P<0.05).Conclusions:Laparoscopy combined with choledochoscopy in the treatment of recurrent intrahepatic and extrahepatic bile duct stones is more effective and safer than open surgery.