腹腔镜联合胆道镜技术治疗复发性肝胆管结石的临床观察

Clinical observation of laparoscopy combined with cholangioscopy in the treatment of recurrent hepatolithiasis

目的观察腹腔镜联合胆道镜技术治疗复发性肝胆管结石的可行性及临床疗效。方法选取我院2013年2月—2017年10月收治的65例复发性肝胆管结石患者,所有病例经临床检查于手术前确诊,告知开放手术和腹腔镜手术的方法,供病人及其家属选择,并签署手术知情同意书。65例患者按照自家意愿实施腹腔镜联合胆道镜技术取出胆道结石(32例),设定为治疗组,对照组(33例)实施常规开腹取石术)。根据设计的观察项目,分析并比较两组患者的临床疗效。结果治疗组患者手术时间、术中出血量、术后肛门排气时间、术后胆红素恢复时间、术后并发症及平均住院时间各项均少于对照组,差异显著(P<0.05);治疗前两组患者胆总管直径无统计学差异,治疗后,治疗组患者胆总管直径明显小于对照组(P<0.05)。结论采用腹腔镜联合胆道镜技术治疗肝胆管结石能获得更好的临床效果,提高结石清除率,安全性高,并发症少,值得临床应用研究。

Objective:To observe the feasibility and clinical efficacy of laparoscopic combined cholangioscopy in the treatment of recurrent hepatolithiasis.Methods:Selection from February 2013 to October 2017 treated 65 cases of patients with recurrent hepatolith,all cases by clinical examination in the diagnosis before surgery,inform the open surgery and laparoscopic surgery method,for patients and their families to choose from,and signed informed consent to surgery.In 65 cases,patients underwent laparoscopy combined with biliary calculus(32 cases)according to their willingness to perform laparoscopy,which was set as the treatment group,and the control group(33 cases)were performed with conventional open-stomach lithography.According to the design observation project,the clinical effect of two groups of patients was analyzed and compared.Results:the treatment group patients with operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative bilirubin recovery time,postoperative complications and the average length of hospital stay were less than the control group,significant difference(P<0.05);There was no difference in the diameter of bile duct in the two groups before treatment.After treatment,the diameter of bile duct in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion:The use of laparoscopy combined with cholangioscope technique to treat hepatobiliary calculi can obtain better clinical effect,improve the removal rate of stone,high safety,less complications,and deserve clinical application research.