廖均平  黄燕金  梁日光  梁永任  欧光武  刘杰文

[摘要] 目的 探讨腹腔镜联合胆道镜治疗肝胆管结石的疗效。 方法 选取2010年6月～2013年6月我院就诊的肝胆管结石65例，随机分为研究组33例及对照组32例。对照组行常规开腹行胆囊切除术，研究组行腹腔镜联合胆道镜治疗。对两组患者的手术情况，术后并发症及复发率进行比较。 结果 研究组的手术时间、出血量、肛门排气时间、住院天数，明显短于对照组，两组比较，差异具有统计学意义（P＜0.05）。研究组的切口感染，术后疼痛，胆漏发生率皆少于对照组，两组比较，差异显著（P＜0.05）。而结石残余率研究组高于对照，差异显著（P＜0.05）。研究组结石复发率为3.03%，明显低于对照组的21.88%，两组比较差异显著（P＜0.05）。 结论对肝胆管结石采用腹腔镜联合胆道镜治疗，其临床疗效显著，可明显降低并发症，值得临床应用。

[关键词] 腹腔镜；胆道镜；肝胆管结石

[中图分类号] R657.4   [文献标识码] B   [文章编号] 2095-0616（2014）09-180-03

Observation of laparoscopy combined with choledochoscopy in treatment of bile duct calculi

LIAO Junping  HUANG Yanjin  LIANG Riguang  LIANG Yongren  OU Guangwu

LIU  Jiewen

Department of Hepatobiliary Surgery, Gaozhou People's Hospital,Gaozhou 525200,China

[Abstract] Objective To explore the  laparoscopy combined with choledochoscopy in treatment of bile duct calculi. Methods 65 cases of hepatobiliary calculi in our hospital from 2010 June to 2013 June were collected and were randomly divided into study group 33 cases and control group of 32 cases.The control group underwent conventional open cholecystectomy, study group underwent laparoscopy combined with choledochoscopy in treatment.The operation situation of two groups of patients, postoperative complications and recurrence rate were compared. Results Research group in the operation time,amount of bleeding,anal exhaust time, hospitalization days,significantly shorter than the control group,the two groups,the difference was statistically significant(P＜0.05).Research group of incision infection, postoperative pain, bile leakage rate is less than that of the control group,the two groups, significant difference(P＜0.05).While the rate of residual stones in study group was higher than that of the control,significant difference(P＜0.05).Research group of stone recurrence rate was 3.03%,significantly lower than the control group 21.88%,the difference between the two groups was significant(P＜0.05).Conclusion Laparoscopy combined with choledochoscopy in the treatment of hepatolithiasis clinical curative effect,can obviously reduce the incidence of complications,worthy of clinical application.

[Key words] Laparoscopy;Choledochoscopy;Hepatolithiasis

肝内胆管结石主要指左右肝管汇合部以上各分枝胆管内的结石，其作为胆管结石的一种类型，通常单独存在，偶尔与肝外胆管结石并存。传统肝内胆管结石开腹手术在临床治疗中具有创伤大，愈合时间长，结石残留率高的缺点[1-2]。随着医疗技术的发展，腹腔镜联合胆道镜治疗肝内胆管结石取得了一定的进展[3-4]。本研究对肝胆管结石采用腹腔镜联合胆道镜治疗，去的较好的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选取2010年6月～2013年6月我院就诊的肝胆管结石65例，其中男35例，女30例，年龄35～76岁，平均（49.7±11.9）岁。……