雷海锋

[摘要] 目的 探讨腹腔镜下经胆囊管胆道探查术与胆总管切开探查术治疗肝外胆管结石的效果。 方法 选取2012年2月～2015年3月铜川矿务局中心医院普外科收治的肝外胆管结石患者110例，依据手术治疗方式不同分为治疗A组50例和治疗B组60例。治疗A组采用胆总管切开探查术，治疗B组采用腹腔镜下经胆囊管胆道探查术。观察两组患者手术时间、术中出血量、住院时间、腹腔引流时间、恢复正常生活时间、总有效率、术后感染发生率、出血发生率、胆漏发生率、结石残留率和复发率。 结果 治疗B组手术时间[（123.6±60.5）min]、住院时间[（4.4±2.0）d]、腹腔引流时间[（2.1±0.5）d]、恢复正常生活时间[（17.1±3.0）d]均短于治疗A组[（172.3±80.4）min、（8.3±2.5）d、（3.9±0.6）d、（22.7±3.4）d]，术中出血量[（80.8±7.4）mL]少于治疗A组[（187.8±10.6）mL]，差异有统计学意义（P < 0.05）。治疗B组总有效率为96.7%，高于治疗A组的78.0%，差异有统计学意义（P < 0.05）。治疗B组术后感染、出血、胆漏发生率均低于治疗A组（1.7%比8.0%、1.7%比8.0%、0.0%比6.0%），差异有统计学意义（P < 0.05）。治疗B组结石残留率和复发率均低于治疗A组（1.7%比10.0%、1.7%比10.0%），差异有统计学意义（P < 0.05）。 结论 腹腔镜下经胆囊管胆道探查术治疗肝外胆管结石的创伤相对较少，并发症少，值得临床推广应用。

[关键词] 腹腔镜；腹腔镜下经胆囊管胆道探查术；胆总管切开探查术；肝外胆管结石

[中图分类号] R575.6+2 [文献标识码] A [文章编号] 1673-7210（2015）10（b）-0089-04

Effect comparison of laparoscopic transcystic common bile duct exploration and common bile duct incision exploration in the treatment of extrahepatic bile duct stone

LEI Haifeng

Department of General Surgery， Central Hospital of Tongchuan Mining Bureau， Shaanxi Province， Tongchuan 727000， China

[Abstract] Objective To explore effect of laparoscopic transcystic common bile duct exploration and common bile duct incision exploration in the treatment of extrahepatic bile duct stone. Methods 110 cases of patients with extrahepatic bile duct stone in Department of General Surgery， Central Hospital of Tongchuan Mining Bureau from February 2012 to March 2015 were selected and divided into treatment group A of 50 cases and treatment group B of 60 cases， according to different surgical treatment methods. Common bile duct incision exploration was used in treatment group A， laparoscopic transcystic common bile duct exploration was applied in treatment group B. Operation time， intraoperative blood loss， length of stay， abdominal cavity drainage time， recovery of normal life time， total effective rate， incidence rate of postoperative infection， incidence rate of bleeding， incidence rate of bile leakage， residual rate of stone and recurrence rate between two groups were observed. Results In treatment group B， operation time [（123.6±60.5）min]， length of stay [（4.4±2.0）d]， abdominal cavity drainage time [（2.1±0.5）d]， recovery of normal life time [（17.1±3.0）d] were shorter than those in treatment group A [（172.3±80.4）min， （8.3±2.5）d， （3.9±0.6）d， （22.7±3.4）d]， intraoperative blood loss [（80.8±7.4）mL] was less than that in treatment group A [（187.8±10.6）mL]， with statistical differences （P < 0.05）. Total effective rate of treatment group B was 96.7%， higher than that of treatment group A （78.0%）， with statistical difference （P < 0.05）. Incidence rate of postoperative infection， bleeding and bile leakage in treatment group B were lower than those in treatment group A （1.7% vs 8.0%， 1.7% vs 8.0%， 0.0% vs 6.0%）， with statistical differences （P < 0.05）. Residual rate of stone and recurrence rate in treatment group B were lower than those in treatment group A （1.7% vs 10.0%， 1.7% vs 10.0%）， with statistical differences （P < 0.05）. Conclusion Trauma of laparoscopic transcystic common bile duct exploration in the treatment of extrahepatic bile duct stone is relatively small， complication is little， it is worthy of clinical popularization and application.endprint

[Key words] Laparoscope； Laparoscopic transcystic common bile duct exploration； Common bile duct incision exploration； Extrahepatic bile duct stone

肝外胆管结石是普外科常见疾病，其发生原因较为复杂，主要是由于肝内外胆管内的结石诱发[1-2]。生理结构上讲，左叶肝管较长，呈水平方向行走，左侧叶肝管和肝总管形成锐角，进而造成胆汁潴留[3-4]。其虽然属于良性疾病，但是肝内胆管结石很容易导致肝脓肿、胆管炎、胆汁性肝硬变等严重的并发症，可能危及患者的生命安全[5-6]。腹腔镜下经胆囊管胆道探查术与胆总管切开探查术是治疗肝外胆管结石常用的方法，目前研究针对胆总管切开探查的说法不一。本研究主要探讨腹腔镜下经胆囊管胆道探查术与胆总管切开探查术治疗肝外胆管结石的效果。……