腹腔镜胆总管切开应用开腹器械取石方法的探讨

Stone removal in laparoscopic choledocholithotomy by routine laparotomic instruments

目的 探讨腹腔镜胆总管切开取石术中用开腹器械取石的可行性。 方法 胆总管结石 73例随机分为两组。实验组 :腹腔镜下采用开腹器械镜下取石。对照组 :腹腔镜下经胆道镜取石网取石。比较两组间的结石除净率、手术时间、住院总费用及并发症。 结果 实验组结石除净率为 94 4 % (34/ 36 ) ,对照组为 94 6 % (35 / 37) (χ2 =0 0 0 0 ,P =1 0 0 0 ) ,两组无差异 ;手术时间实验组为 (1 5 0 9± 2 6 8)min ,低于对照组的 (1 72 3± 2 8 6 )min(t=3 2 97,P =0 0 0 2 ) ;住院总费用实验组为 (4 4 0 0±1 1 0 0 )元 ,低于对照组的 (5 0 0 0± 1 30 0 )元 (t=2 1 2 6 ,P =0 0 37)。两组均无严重的手术并发症。 结论 腹腔镜下采用开腹器械和胆道镜取石都是安全、可靠的 ,采用开腹器械取石费用低 ,手术时间短。

Objective To discuss the feasibility of stone removal in laparoscopic choledocholithotomy by routine laparotomic instruments. Methods A total of 73 patients with common bile duct stones were divided randomly into 2 groups: the Experimental Group received laparoscopic stone removal by routine laparotomic instruments; the Control Group received stone removal by choledochoscopic net-basket. The stone-free rate, operative time, total hospitalization costs and postoperative complications between the two groups were compared. Results There were no statistical significances in stone-free rate between the Experimental Group ( 94.4% , 34/36) and the Control Group (94.6%, 35/37) ( χ 2=0.000, P =1.000). The operative time in the Experimental Group (150.9 min±26.8 min) was shorter than that in the Control Group (172.3 min±28.6 min) ( t=3.297, P =0.002), whereas the total hospitalization costs in the Experimental Group (4400 yuan±1100 yuan) was lower than that in the Control Group (5000 yuan±1300 yuan) ( t=2.126, P= 0.037). No severe operation-related complications were observed in both of the groups. Conclusions Laparoscopic choledocholithotomy by either routine laparotomic instruments or choledochoscopy is safe and effective. Stone removal by routine laparotomic instruments has the advantages of low costs and short operative time.