徐东建

[摘要] 目的 探讨腹腔镜结合纤维胆道镜胆总管切开取石的可行性及治疗效果。方法 整群选取该院在2009年6月—2014年6月期间收治的60例行腹腔镜结合纤维胆道镜治疗的胆总管结石患者，将其设为观察组患者，同时选取60例采用开腹手术进行治疗的胆总管结石患者作为该次研究的对照组。将两组患者的相关临床指标进行对比。 结果 观察组患者的手术时间（125.2±16.3） min、胆瘘发生率（1.7%）、残石发生率（3.3%）与对照组患者手术时间（119.3±15.4）min、术后胆瘘发生率（3.3%）、残石发生率（5.0%）相比，差异无统计学意义（P>0.05）；与对照组相比，观察组患者的术后排气恢复时间（24.2±5.6） h、术后住院天数（5.4±2.8） d、术中出血量（45.5±11.7） mL显著较少（P<0.05）；观察组患者术后疼痛率（23.3%）以及术后切口感染率（0.0%）均低于对照组患者术后疼痛率（85.0%）以及术后切口感染率（15.0%），差异有统计学意义（P<0.05）。结论 腹腔镜结合纤维胆道镜胆总管切开取石能够促进患者术后尽快恢复，减少对患者的创伤性，具有安全性与可靠性。但需要严格选择适应症进行胆总管Ⅰ期缝合或者T管引流，这样会达到更佳的微创效果。

[关键词] 腹腔镜；纤维胆道镜；胆总管结石；治疗体会

[中图分类号] R657 [文献标识码] A [文章编号] 1674-0742（2015）12（c）-0014-03

To Explore the Treatment of 60 Cases with Choledocholithiasis Treated by Choledocholithotomy with Laparoscope and Choledochofiberscope

XU Dong-jian

Department of General Surgery， Jiangsu Xiangshui Peoples Hospital， Xiangshui， Jiangsu Province， 224600 China

[Abstract] Objective To investigate the feasibility and effect of choledocholithotomy with laparoscope and choledochofiberscope in the treatment of choledocholithiasis. Methods 60 patients with choledocholithiasis treated by choledocholithotomy with laparoscope and choledochofiberscope and other 60 patients with choledocholithiasis treated by open choledocholithotomy in our hospital from June 2009 to June 2014 were selected as the observation group and the control group， respectively. And the values of relative clinical indexes of the two groups were compared. Results There was no statistically significant difference between the two groups in the duration of procedure [（125.2±16.3） min vs （119.3±15.4） min]， incidence of biliary fistula （1.7% vs 3.3%）， incidence of residual stone （3.3% vs 5.0%） with no statistically significant difference （P>0.05）. The first exhaust time， postoperative hospital stay， and intraoperative blood loss was （24.2±5.6） h， （5.4 ± 2.8） d，（45.5 ± 11.7） mL respectively in the observation group， which was much less than that in the control group， respectively （P<0.05）. Compared with the control group， the observation group had lower proportion of patients with postoperative pain （23.3% vs 85.0%） and postoperative wound infection rate （0 vs 15.0%）， the differences were statistically significant（P<0.05）. Conclusion Choledocholithotomy with laparoscope and choledochofiberscope is safe and reliable， which can promote the postoperative recovery as soon as possible and reduce the trauma. However， it is necessary to strictly select the indications for the common bile duct I suture or T tube drainage， which will achieve a better minimally invasive effect.

[Key words] Laparoscope； Choledochofiberscope； Choledocholithiasis； Treatment experience

随着微创技术的不断发展与成熟，腹腔镜结合纤维胆道镜胆总管切开取石术成为了继腹腔镜胆囊切除术之后的又一重大飞跃，该手术方法在胆总管结石的治疗中得到了广泛的应用[1]。腹腔镜联合纤维胆道镜手术能够减轻患者的疼痛，减少对患者腹腔内脏器的干扰，还能够减少患者术中的出血量，且Ⅰ期缝合的患者可以免受长期T管的痛苦，但是该手术方法在放置T管引流以及缝合方面花费了较多的时间，而且该手术方法对于胆总管内较大的结石处理起来比较困难，同时对术者腹腔镜下缝合技术具有非常高的要求。该次研究整群选取该院2009年6月—2014年6月收治的60例胆总管结石患者行腹腔镜结合纤维胆道镜胆总管切开取石术进行治疗，同时采用开腹手术对同期60例胆总管结石患者进行治疗，旨在深入探讨腹腔镜结合纤维胆道镜胆总管切开取石术的治疗效果，现报道如下。