腹腔镜联合胆道镜在胆总管探查取石术中的应用

Application of Laparoscopic Combined with Choledochoscopy in Common Bile Duct Exploration and Stone Removal

目的探讨腹腔镜联合胆道镜在胆总管探查取石术中的应用效果。方法该研究回顾性分析2014年1月-2018年1月该院因胆总管结石接受手术治疗的98例患者资料,根据手术方法将其分为腔镜组49例和剖腹组49例。剖腹组采用传统的剖腹探查术,腔镜组行腹腔镜胆囊切除术。比较两组手术时间、术中出血量、腹腔引流量、术后胃肠功能恢复时间、住院时间、切口感染率。同时,随访1年,对比两组胆管残留与胆管狭窄的发生率。结果剖腹组手术时间(121.5±35.5)min、术中出血量(110.5±15.5)mL、腹腔引流量(60.2±17.3)mL、术后胃肠功能恢复时间(80.5±17.3)h、住院时间(14.2±1.8)d均高于腔镜组(90.5±15.8)min、(40.5±11.8)mL、(30.2±15.8)m L、(48.5±5.8)h、(7.2±1.2)d(t=9.546、11.526、8.526、7.856、7.526,P<0.05)。腔镜组术后无切口感染病例,剖腹组术后出现切口感染6例,腔镜组术后切口感染率0.00%低于对剖腹组12.24%(χ2=4.438,P<0.05)。术后随访1年,两组患者均行常规行肝功能、B超、CT或MRCP检查,未见胆管残留结石和胆管狭窄。结论腹腔镜联合胆道镜在胆总管探查取石术中具有显著的应用效果,能够加快患者的康复速度,降低感染概率,值得临床推广。

Objective To investigate the effect of laparoscopic combined with choledochoscopy in the exploration of common bile duct exploration. Methods This study retrospectively analyzed the data of 98 patients who underwent surgery for choledocholithiasis from January 2014 to January 2018. According to the surgical method, they were divided into 49 cases of laparoscopic group and 49 cases of laparotomy group. The laparotomy group underwent conventional laparotomy and the laparoscopic group underwent laparoscopic cholecystectomy. The operation time, intraoperative blood loss, abdominal drainage volume, postoperative gastrointestinal function recovery time, hospitalization time, and incision infection rate were compared between the two groups. At the same time, follow-up was performed for 1 year, and the incidence of bile duct residual and bile duct stenosis was compared between the two groups. Results The operation time of laparotomy group(121.5±35.5) min,intraoperative blood loss(110.5±15.5)mL, abdominal drainage volume(60.2±17.3) m L, postoperative gastrointestinal function recovery time(80.5±17.3)h, hospitalization time(14.2±1.8)d were higher than the laparoscopic group(90.5 ±15.8) min,(40.5±11.8)mL,(30.2±15.8)mL,(48.5±5.8)h,(7.2±1.2)d(t=9.546, 11.526, 8.526, 7.856, 7.526, P<0.05). There were no incision infections in the laparoscopic group. Six cases of wound infection occurred in the laparotomy group. The incision infection rate of the laparoscopic group was 0.00% lower than that of the laparotomy group(12.24%, χ2=4.438, P<0.05). All patients were followed up for 1 year. All patients underwent routine liver function, B-ultrasound, CT or MRCP examination.No residual bile duct stones and bile duct stricture were found. Conclusion Laparoscopic combined with choledochoscopy has significant application effects in common bile duct exploration and stone removal. It can speed up the recovery of patients and reduce the probability of infection, which is worthy of clinical promotion.