腹腔镜胆总管切开取石术:硬镜和软镜对照研究

Rigid nephroscopy vs flexible cholangioscopy in laparoscopic common bile duct exploration for patients with choledocholithiasis

目的研究对比硬质肾镜、纤维胆道镜引导下的腹腔镜胆总管切开取石术治疗胆总管结石的安全性和有效性。方法回顾性分析2011年1月至2013年3月我院80例腹腔镜胆总管切开取石术治疗胆总管结石的病例资料,按照所使用的内镜不同分为硬质肾镜组(38例)和纤维胆道镜组(42例),对比两组之间的近期、远期疗效。结果两组患者的平均手术时间(90 min vs 85 min)、平均术后住院时间(4.1 d vs 4.2 d)、术后并发症发生率(2.6%vs 2.4%)、结石残留率(5.3%vs 2.4%)等方面差异均无统计学意义(P>0.05),无一例患者死亡。结论对于技术熟练的胆道外科医生,硬质肾镜、纤维胆道镜引导下腹腔镜胆总管切开取石术治疗胆总管结石均是安全、有效的。

Objective To investigate the safety,efficacy and surgical outcomes of laparoscopic common bile duct exploration (LCBDE)by rigid nephroscopy or flexible cholangioscopy in patients with common bile duct stones (CBDS). Methods The retrospective study enrolled 80 patients with LCBDE from January 2011 to march 2013,they were randomized into 2 groups:LCBDE-R group,38 patients with LCBDE by rigid nephroscopy;LCBDE-F group,42 patients with LCBDE by flexible cholangioscopy. The short -term and long -term effects data were analyzed between the two groups. Results The average operation time (90 min vs 85 min),the average postoperative hospital stay (4.1 days vs 4.2 days),the major postoperative complications rate(2.6% vs 2.4%),the mortality rate(0 vs 0)and the rate of residual stones (5.3% vs 2.4%)of the LCBDE-R group and LCBDE-F group were similar (P>0.05). No patient died. Conclusion Both LCBDE with rigid nephroscopy and flexible cholangioscopy are equally highly safe and efficient,and equipments should be in the armamentarium of the biliary surgeons performing LCBDE.