戴贵森　方迎兵福建医科大学附属龙岩第一医院普外二科，福建龙岩　364000

腹腔镜与胆道镜联合治疗肝胆管结石的临床疗效

戴贵森方迎兵
福建医科大学附属龙岩第一医院普外二科，福建龙岩364000

目的探讨腹腔镜与胆道镜联合治疗肝胆管结石的临床疗效。 方法随机抽取2013年1月～2015年1月我院收治的88例肝胆管结石患者的一般资料，所有患者均经临床检查，确诊为肝胆管结石，并自愿签署知情同意书。将88例患者按照随机数字表法分为实验组（腹腔镜与胆道镜联合取石）与对照组（常规开腹取石术）。分析两组患者治疗效果。结果实验组手术时间、术中出血量、住院时间、肛门排气时间均少于对照组，差异有统计学意义（P＜0.05）；治疗前，两组患者肝胆总管直径对比，差异无统计学意义（P＞0.05）；治疗后，实验组患者肝胆总管直径明显短于对照组，差异有统计学意义（P＜0.05）；实验组患者术后并发症发生率为9.1%（4/44），明显低于对照组的29.5%（13/44），差异有统计学意义（P＜0.05）。结论在肝胆管结石患者治疗中采用腹腔镜与胆道镜联合取石，能获得较好的临床效果，提升清石率，且术后并发症少，安全可靠，值得进行深入研究和推广。

肝胆管结石；腹腔镜；胆道镜；取石术

［Abstract］Objective To exp1ore the c1inica1 effects of 1aparoscopy combined with cho1edochoscopy in the treatment of hepato1ithiasis.Methods Genera1 data of 88 patients with hepato1ithiasis who were admitted to our hospita1 from January 2013 to January 2015 were random1y se1ected.A11 patients were given c1inica1 examination，diagnosed with hepato1ithiasis，were wi11ing to sign the informed consent form.The 88 patients were assigned to the experiment group（1aparoscopy combined with cho1edochoscopy）and the contro1 group（regu1ar 1aparoscopy）according to the random number tab1e.Curative effects were compared and ana1yzed between the two groups of patients.Results Surgery time，amount of b1eeding during surgery，1ength of stay and time of passage of gas in the experiment group were a11 1ower or shorter than those in the contro1 group，and the differences were significant（P＜0.05）；before the treatment，there was no significant difference of the diameter of common hepatic duct and common bi1e duct between the two groups（P＞0.05）；after the treatment，the diameter of common hepatic duct and common bi1e duct in the experiment group was significant shorter than that in the contro1 group，and the differences were significant（P＜0.05）；the incidence rate of postoperative comp1ications was 9.1%（4/44）in the experiment group，significant1y 1ower than that of 29.5%（13/44）in the contro1 group，and the difference was significant（P＜0.05）.Conclusion Laparoscopy combined with cho1edochoscopy in the treatment of hepato1ithiasis is ab1e to acquire favorab1e c1inica1 effects，and improve stone c1earance rate.It a1so has fewer postoperative comp1ications，and is safe and re1iab1e，which is worthy of in-depth study and promotion.

［Key words］Hepato1ithiasis；Laparoscopy；Cho1edochoscopy；Lithotomy

作为临床上一种常见的胆管结石，肝内胆管结石主要是指发生于患者左右肝管汇合部以上各分枝胆管内的结石［1］。而且，若患者结石长期存在，会导致肝胆管出现纤维化病变，且不断萎缩，致使胆管变形或扩张，诱发肝硬化等疾病，增加患者死亡率［2］。……