腹腔镜联合胆道镜胆总管切开取石术疗效观察

Observation on the efficacy of laparoscopic and choledochoscopic common bile duct incision and lithotripsy

目的探讨腹腔镜联合胆道镜胆总管切开取石术的疗效。方法选取2016年1月~2017年1月我院住院治疗的60例胆结石患者作为研究对象,均经病史、症状、体征、B超、CT或MRI等检查确诊,所有患者采用随机数字表法随机分为观察组与对照组,各30例,对照组患者行传统开腹胆总管结石取石术,观察组患者行腹腔镜联合胆道镜胆总管切开取石术,比较两组的手术效果。结果观察组患者的手术时间与对照组比较显著缩短,观察组患者的胃肠功能恢复时间、住院时间与对照组比较明显缩短,组间比较差异具有统计学意义(P<0.05)。观察组患者的一次性取石成功率为96.7%、对照组为70.0%(21/30),组间比较差异具有统计学意义(P<0.05)。观察组患者术后无一例出现切口感染,其术后并发症发生率仅6.7%,显著低于对照组,组间比较差异具有显著性(P<0.05)。结论腹腔镜联合胆道镜胆总管切开取石术较传统开腹胆总管结石取石术可以显著缩短手术时间、操作简单、术后恢复快、术后并发症少,住院时间短。

Objective To explore the efficacy of laparoscopic and choledochoscopic common bile duct incision and lithotripsy.Methods 60 patients with gallstones who were hospitalized in our hospital from January 2016 to January2017 were selected as the study subjects.All patients were diagnosed by history,symptoms,signs,B-mode ultrasound,CT or MRI.All patients were randomly divided into observation group and control group using random number table method,with 30 patients in each group.Patients in the control group were given traditional open surgery for common bile duct lithotripsy.Laparoscopic and choledochoscopic common bile duct incision and lithotripsy was performed in the observation group.The surgical results were compared and analyzed between the two groups.Results The operation time in the observation group was significantly shorter than that in the control group.The recovery time of gastrointestinal function and the length of stay in the observation group were significantly shorter than those in the control group.There was significant difference between the two groups（P〈0.05）.In the observation group,the successful rate of one-time stone removal was 96.7%.the control group was 70.0%（21/30）.There was significant difference between the two groups（P〈0.05）.No incision infection occurred in the observation group after surgery.The incidence rate of postoperative complications was only 6.7%,which was significantly lower than that in the control group.There was significant difference between the two groups（P〈0.05）.Conclusion Laparoscopic and choledochoscopic common bile duct incision and lithotripsy,compared with the convential open common bile duct lithotripsy,can significantly shorten the operation time,with simple operation,rapid postoperative recovery,less postoperative complications and short length of hospital stay.It is worthy of extensive promotion and application.