鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内外胆管结石的临床价值

Clinical value of rigid choledochoscopic under sheath protection in the treatment of intrahepatic and extrahepatic bile duct calculus through laparoscopic common bile duct approach

目的探讨鞘管保护下硬质胆道镜(硬镜)经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的临床价值。方法选取115例肝内外胆管结石患者作为研究对象。根据手术方法将患者分为硬镜组58例、软镜组57例,硬镜组采用鞘管保护下硬质胆道镜经腹腔镜胆总管入路取石治疗,软镜组采用纤维胆道镜经腹腔镜胆总管入路取石治疗。比较两组患者的手术时间、术中出血量、术后住院时间、结石清除率,以及术后第1天肝功能(空腹静脉血总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平)、术后并发症发生情况等。结果硬镜组患者的手术时间短于软镜组,结石清除率高于软镜组,差异均有统计学意义(均P<0.05);两组患者的术中出血量、术后住院时间、术后并发症发生率,以及术后第1天总胆红素、直接胆红素、碱性磷酸酶、γ-谷氨酰转移酶水平比较,差异均无统计学意义(均P>0.05)。结论鞘管保护下硬质胆道镜经腹腔镜胆总管入路治疗肝内胆管结石和胆总管结石的手术时间短、结石清除率高,是一种安全、高效的手术策略,具有一定的潜在应用价值。

Objective To explore the clinical value of rigid choledochoscope under sheath protection in the treatment of intrahepatic bile duct calculus and common bile duct calculus through laparoscopic common bile duct approach.Methods A total of 115 patients with intrahepatic and extrahepatic bile duct calculus were selected as research objects.According to the operation method,patients were divided into rigid choledochoscope group(n=58) and fiber choledochoscope group(n=57).The rigid choledochoscope group was treated with rigid choledochoscope under the sheath protection through laparoscopic common bile duct approach,and the fiber choledochoscope group was treated with fiber choledochoscope through laparoscopic common bile duct approach.The operation time,intraoperative blood loss,postoperative hospital stay,caculus clearance rate,liver function(fasting venous blood levels of total bilirubin,direct bilirubin,alkaline phosphatase,γ-glutamyltransferase) on the first day after operation,and postoperative complications were compared between the two groups.Results The operation time was shorter and the calculus clearance rate was higher in the rigid choledochoscope group than those in the fiber choledochoscope group,with statistically significant differences(all P<0.05).There were no statistically significant differences in intraoperative blood loss,postoperative hospital stay,incidence of postoperative complications,and the levels of total bilirubin,direct bilirubin,alkaline phosphatase,γ-glutamyltransferaseon the first day after operation between the two groups(all P>0.05).Conclusion Rigid choledochoscope under sheath protection in the treatment of intrahepatic bile duct calculus and common bile duct calculus through laparoscopic common bile duct approach has short operation time and high calculus clearance rate,which is a safe and efficient surgical strategy with certain potential application value.