双镜联合保胆取石的临床可行性与安全性

Clinical feasibility and safety of gallbladder-preserving lithotripsy with laparoscopy and choledochoscopy

目的探讨腹腔镜联合胆道镜保胆取石的临床效果及安全性。方法收集浙江衢化医院2011年1月至2016年1月总共664例胆囊结石患者作为研究对象,分为两组:对照组312例,采取腹腔镜胆囊切除术;试验组352例,行腹腔镜联合胆道镜保胆取石术。分析两组手术时间、术中出血量、排气时间、下床活动时间、住院时间、并发症发生率差异,并统计试验组5年内的胆囊收缩率、胆囊壁厚度变化、结石复发率。结果两组手术时间、术中出血量、排气时间、下床活动时间、住院时间及并发症发生率差异无统计学意义(P<0.05)。在5年的随访时间内,试验组失访19例,术后胆囊收缩功能及胆囊壁厚度较术前明显改善,差异有统计学意义(P<0.05),5年结石复发率6.58%。结论腹腔镜联合胆道镜行保胆取石术,在取出结石的同时保留胆囊功能,创伤小、安全性高;且并发症相对于传统手术更少,复发率低,疗效确切。在严格掌握适应证的前提下,这是临床治疗胆囊结石的较为理想的术式。

Objective To investigate the efficacy of gallbladder-preserving lithotripsy with laparoscopy and choledochoscopy.Methods Six hundred and sixty-four cases of cholecystolithiasis were divided into control group(312 cases,treated with laparoscopic cholecystectomy)and experimental group(352 cases,treated with gallbladder-preserving lithotripsy by laparoscopy and choledochoscopy).Operation time,intraoperative blood loss,evacuation time,normal activity time,hospitalization duration,complication incidence were compared between two groups.The gallbladder wall thickness,gallbladder contraction ratio and recurrence rate of gallstone in 5-year follow-up were analyzed in the experimental group.Results There were no statistical significance in operation time,intraoperative blood loss,evacuation time and complication incidence rate between two groups(P>0.05).There were 19 cases lost to follow-up in the experimental group.During 5-year follow-up,the gallbladder shrinking function and the gallbladder wall were improved obviously(P<0.05)and recurrence rate of gallstone was 6.58%.Conclusion Gallbladder-preserving lithotripsy with laparoscopy and choledochoscopy can reserve the function of gallbladder,with more safety,less trauma,less complications.The curative effect compared with traditional operations is definite.Under the premise controlling of the indication and contraindication,cholecystolithotomy may be the ideal choice for gallstone.