腹腔镜与胆道镜联合取石术治疗肝内胆管结石疗效观察

Clinical efficacy of laparoscopic combined with choledochoscopic lithotomy in the treatment of hepatolithiasis

目的探讨腹腔镜与胆道镜联合取石术治疗肝内胆管结石的临床疗效。方法将2015年3月至2017年2月间东莞市常平医院90例肝内胆管结石患者根据随机数表法分为观察组和对照组各45例。观察组应用腹腔镜联合胆道镜取石,对照组应用传统开腹联合胆道镜取石,观察两组患者的手术时间、术中出血量、术后排气时间、住院时间及碎石率和术后并发症情况。结果观察组患者的手术时间明显长于对照组[(178.4±32.5)min vs(89.9±24.6)min],术中出血量[(80.1±17.5)m L vs(368.5±115.8)m L]、术后排气时间[(52.9±12.6)h vs(90.6±26.8)h]及住院时间[(9.2±3.8)d vs(18.9±6.4)d]明显少于对照组,差异均有统计学意义(P<0.05);观察组患者的一期手术碎石率为91.1%,对照组为86.7%,差异无统计学意义(P>0.05);观察组患者术后并发症发生率为4.4%,明显低于对照组的20.0%,差异有显著统计学意义(P<0.01)。结论腹腔镜与胆道镜联合取石术能明显缩短肝内胆管结石患者手术出血量和住院时间,减少术后并发症发生,但是不会提升一期手术碎石率。

Objective To evaluate the clinical efficacy of combined use of laparoscopic and choledochoscopic lithotomy for treatment of hepatolithiasis. Methods From March 2015 to Februrary 2017, 90 hepatolithiasis patients in Changping Hospital were randomly divided into observation group and control group, with 45 patients in each group. The observation group applied laparoscope combined with choledochoscopic lithotomy, while the control group used conventional laparotomy combined with choledochoscopy. The operation time, intraoperative bleeding volume, postoperative exhaust time, hospitalization time, postoperative complications, and rate of lithotripsy were observed. Results The operation time, intraoperative bleeding volume, postoperative exhaust time, hospitalization time were（178.4±32.5） min,（80.1±17.5） m L,（52.9±12.6） h,（9.2±3.8） d in the observation group, versus（89.9±24.6） min,（368.5±115.8） m L,（90.6±26.8） h,（18.9±6.4） d in the control group（P〈0.05）. The rate of lithotripsy was 91.1% in the observation group, as compared with86.7% in the control group（P〉0.05）. The rate of complications in the observation group was significantly lower than that in the control group（4.4% vs 20.0%, P〈0.01）. Conclusion Laparoscopic combined with choledochoscopic lithotomy in the treatment of hepatolithiasis can decrease the bleeding volume, shorten the hospitalization time, reduce postoperative complications, but does not improve the rate of lithotripsy.