腹腔镜联合胆道镜治疗肝内外胆管结石随机平行对照研究

Laparoscope Combined with Choledochoscope in Treatment of Intrahepatic Biliary Calculi Random Parallel Control Study

[目的]观察腹腔镜联合胆道镜治疗肝内外胆管结石疗效。[方法]使用随机平行对照方法,将43例住院患者按随机数字表法分为两组。对照组20例传统开腹取石,手术在全麻情况下进行,先行造影(ERCP)检查,明确结石大小。确定切口开腹,仔细检查肝内外胆管,术中直接用石钳取石,术后留置T管引流。治疗组23例腹腔镜联合胆道镜取石,患者均全麻,患者取仰卧位,采用四孔法建立气腹。置入器械,超声刀将粘连分离,明确胆囊管、胆囊动脉及胆总管,分离胆囊动脉,常规切除胆囊。分离胆总管前壁,使胆总管及肝总管显露出来,切开胆总管前壁,将纤维胆道镜插入胆总管内,探查胆总管及肝内胆管,取出管内结石,向胆总管注生理盐水,检查残留结石,确认结石取净,反复冲洗。留置T管,严密缝合胆总管,进行腹腔引流,术后复方胆通胶囊,2粒/次,3次/d。西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、术后并发症发生率、不良反应。连续治疗1疗程,判定疗效。[结果]治疗组术后并发胆道出血1例(4.3%),胆漏1例(4.3%)。对照组术后并发胆道感染2例(10%),胆道出血3例(15%),胆漏3例(15%)。治疗组术后发生胆道感染、胆道出血、胆漏的比例均显著低于对照组(P<0.05)。[结论]腹腔镜联合胆道镜治疗肝内外胆管结石疗效显著,术后采用复方胆通胶囊进行调理,效果更佳,可有效减少并发症,值得推广。

[Objective]To observe the the laparoscopy combined choledochoscope treatment the efficacy of the extrahepatic bile duct stones.[Methods]Using random parallel control method,43 patients hospitalized patients into two groups according to random number table method.Control group 20 cases take stone,traditional laparotomy operation under the condition of general anesthesia,leading imaging(ERCP) check,clear stone size.To determine incision open,carefully check,of bile duct of liver inside and outside straight or move the stone pliers lithotomy.Postoperative indwelling T tube drainage,compound bile tong capsule,granule /2 times,3 times / day.Joint choledochoscope treatment group 23 cases of laparoscopic lithotomy,patients during anesthesia,the patient in the supine position,four hole method is adopted to establish pneumoperitoneum.Implant,ultrasonic knife adhesion separation,cystic duct and cystic artery and bile duct,separation of gallbladder artery,routine removal of the gallbladder.Before the separation of common bile duct wall,make the common bile duct and hepatic duct was cut before the common bile duct wall,insert fiber choledochoscope bile total tube,exploration of common bile duct and bile duct inside liver,take out the tube stones,to the common bile duct physiological saline injection,check the residual calculi,confirm the stone net,repeated washing.T tube,tight suture bravery manager for abdominal cavity drainage,compound biliary postoperative capsule,granule /2 times,3 times / day.Western medicine treatment with the control group.7days continuous treatment for 1 course of treatment.Observation of clinical symptoms,the incidence of postoperative complications and adverse reactions.Continuous treatment 1 course of treatment,judge curative effect.[Results]The postoperative concurrent biliary tract bleeding in 1 case(4.3%),bile leakage in 1 case(4.3%).Control group,postoperative biliary tract infection in 2 cases(10%),biliary tract bleeding in 3 cases(15%),the bile leakage 3 cases(15%).Treatment group postoperative biliary tract infections,biliary tract bleeding,bile leakage ratio were significantly lower than the control group(P < 0.05).[Conclusion]Laparoscopic treatment of extrahepatic biliary duct stones mirror effect is significant,postoperative biliary using Compound Capsule conditioning,better,can effectively reduce complications,worthy of promotion.