腹腔镜胆道探查取石T管引流术的临床研究

A RANDOM CONTROLLED STUDY ON METHOD CHOICE AND ITS INDICATION OF LAPAROSCOPIC EXPLORATION OF BILE DUCT AND STONE DETECTION

目的 探讨腹腔镜胆总管探查取石的最佳手术方法及手术适应证的选择。方法 对我中心实施 12 4例腹腔镜胆囊切除与胆总管切开取石探查、T管引流术进行分析 ;其中 82例改进术式 ,中转开腹 4例 ,平均手术时间 80± 30分钟 ,中转开腹率 5 % ;常规术式 4 2例 ,中转开腹 6例 ,平均手术时间 170± 4 0分钟 ,中转开腹率 14 % ,改进术式是对于常规术式中胆总管显露方法及胆总管探查器械的改进。结果 改进术式在手术操作时间上有显著差异 (P<0 .0 1)。中转开腹率有差异 (P<0 .0 5 ) ,在疗效和住院日无差异。结论 腹腔镜胆总管切开探查取石、T管引流术是治疗胆总管结石安全有效的措施 。

Objective To investigate the best method and the indictation of laparoscopic exploration for common bile duct stone.Methods 82 cases underwent laparoscopic choledocholithotomy with self made T tube and improved procedures of exposing the field.42 cases received traditionl method.A controlled analysis was preformed with operting time,hospital stay and effects.Results The two methods had no significant difference on effect and hospital time.But laparoscopic choleocholithotomy with self made T tube and improved procedures of exposing the field could shorten operation time significantly(mean operating time 80±30 min,P<0.01)and reduce the open rate(5%,P<0.05).Conclusion Traditional open laparoscopic exlporation of the common bile duct and stone detection and'T'tube drainage is a safe and effective method for stone in common bile duct.However,improved laparpscopic cholecystecmies,laparoscopic exploration of the common bile duct,stone detection and 'T'tube drainage may be better.