小切口联合胆道镜保胆取石术在基层医院的应用体会

Experience of Application of Small Incision Combined With Biliary Endoscopic Biliary Stone Extraction in Basic-level Hospital

目的评价小切口联合胆道镜保胆取石术在基层医院应用的可行性及临床应用价值。方法回顾性分析我院2012年4月—2014年1月行小切口联合胆道镜保胆取石术的120例患者作为实验组,另外行常规开腹切口的120患者作为对照组,对手术时间、术后肠功能恢复时间、住院时间、结石复发情况进行观察。结果实验组120例手术全部成功,平均手术时间(61.6±11.0)min,肠功能恢复时间(21.4±5.4)h,住院时间(10.9±3.5)天;实验组所有患者均治愈出院,有3例于半年后复发,另有3例于3年后复发,均再行腹腔镜下胆囊切除术,1例于3年后复发胆囊结石伴胆源性胰腺炎,待胰腺炎恢复后行腹腔镜下胆囊切除术。结论小切口联合胆道镜保胆取石术手术风险小,技术难度不大,对于胆囊功能良好、有保胆意愿的患者,小切口联合胆道镜保胆取石术值得应用。

Objective To evaluate the feasibility and clinical value of small incision combined with choledochoscopy for gallstone removal in primary hospitals.Methods A retrospective analysis was made on 120 patients who underwent small incision cholelithotripsy from April 2012 to January 2014 in our hospital as experimental group,and 120 patients who underwent conventional open incision as control group.The operation time,recovery time of intestinal function,hospitalization time and recurrence of stones were observed.Results All the 120 cases in the experimental group were successfully operated,the average operation time was (61.6±11.0) min,the recovery time of intestinal function was (21.4±5.4) h and the hospital stay was (10.9±3.5) days.All the patients were cured,3 cases relapsed after half a year,and 3 cases relapsed after 3 years.All of them underwent laparoscopic cholecystectomy,1 cases had cholecystolithiasis with biliary pancreatitis after three years.Laparoscopic cholecystectomy was performed after pancreatitis was restored.Conclusion Small incision combined with choledochoscope and choledocholithotomy is of small risk,and the technical difficulty is small.For the patients with good gallbladder function and the willingness to protect the bile,small incision combined with choledochoscopy should be popularized in the primary hospital.