腹腔镜、胆道镜联合保胆取石术的临床应用研究

Clinical Application of Laparoscopic and Choledochoscopic Combined Gallbladder Lithotomy

目的分析胆囊结石患者行腹腔镜、胆道镜联合保胆取石术的临床可行性。方法方便选取2016年10月—2017年11月期间医院收治的83例胆囊结石患者作为该次观察对象,按病床单双号将患者分组,观察组42例(行腹腔镜、胆道镜联合保胆取石术)、对照组41例(行腹腔镜胆囊切除术),比较不同术式临床手术情况及术后患者恢复情况,观察组患者出院前复查B超,统计结石残留率,出院后口服牛磺熊去氧胆酸胶囊及消炎利胆片预防术后结石复发,门诊随访4~12个月,复查B超提示胆囊收缩功能良好,无结石复发。结果两组术中情况及术后恢复情况比较中,观察组患者的手术时间、胃肠道功能恢复、术中出血量以及住院时间分别为(40.7±3.5)min、(13.6±2.3)h、(7.6±1.3)mL、(4.6±0.5)d均少于对照组,差异有统计学意义(t=13.432、17.620、52.519、16.507,P<0.05)。且观察组并发症发生率4.8%明显低于对照组的14.6%,差异有统计学意义(χ2=5.482,P<0.05)。结论胆囊结石患者行腹腔镜、胆道镜联合保胆取石术,不仅具有微创优势,术中创伤小、出血量少,术后恢复快、并发症少,其关键是把握适应证,术后预防性用药,同时术者需熟练掌握胆道镜技术及腹腔镜技术,是胆囊结石的理想手术方法,值得推广应用。

Objective To analyze the clinical feasibility of laparoscopic and choledochoscopic combined gallbladder lithotripsy in patients with gallstones. Methods 83 patients with gallstones admitted to the hospital from October 2016 to Novomber 2017 were convenient selected as the subjects for this observation. The patients were divided into two groups according to the diseased bed sheets. The observation group consisted of 42 patients（who underwent laparoscopy and choledochoscopy combined with gallstone removal） and the control group of 41 cases（according to laparoscopic cholecystectomy）.Comparison of different surgical procedures and recovery of postoperative patients was implemented. The observation group patients were examined with B ultrasound before discharge and the residual rate of stones was counted. Oral taurine deoxycholic acid capsules were discharged after discharge. And Xiaoyan Lidan Tablets to prevent postoperative stone recurrence,outpatient follow-up 4 to 12 months, review of B-mode ultrasound prompts good gallbladder systolic function, no recurrence of stones. Results During the comparison of the intraoperative conditions and postoperative recovery of the two groups, the operative time, gastrointestinal function recovery, intraoperative blood loss, and length of hospital stay in the observation group were（40.7±3.5）min,（13.6±2.3）h,（7.6±1.3）mL,（4.6±0.5）d were all less than the control group, and the difference was statistically significant（t=13.432, 17.620, 52.519,16.507, P0.05）. The incidence of complications in the observation group was significantly lower than that in the control group（4.8% vs 14.6%）, and the difference was statistically significant（χ^2=5.482, P〈0.05）. Conclusion Laparoscopic and choledochoscope combined with cholecystectomy for gallbladder stones is not only minimally invasive, but also has less trauma, less blood loss, rapid postoperative recovery and less complications. The key is to grasp indications and postoperative prevention. The use of drugs, at the same time the surgeon must be skilled in choledochoscopy and laparoscopic techniques, is an ideal surgical method for gallbladder stones, it is worth promoting.