孙鹏飞 徐立群 时坤 穆向明 钱洋洋

[摘要] 目的 探析腹腔鏡胆总管探查取石与开腹胆总管探查取石的临床对照。方法 方便选取该院在2014年4月—2018年4月期间收治的128例胆囊结石合并胆总管结石患者，将其随机分为研究组和对照组，各64例，对照组以开腹胆总管探查取石，研究组腹腔镜胆总管探查取石，比较两组取石效果，手术时间、术中失血量、肠功能恢复时间、住院时间及下床活动时间等。 结果 研究组结石取净率98.44%与对照组比较差异无统计学意义（χ2=0.183，P>0.05）;研究组手术时间（60.4±14.6）min、术中失血量（58.3±7.3）mL、肠功能恢复时间（16.2±2.2）h、住院时间（5.0±1.1）d及下床活动时间（3.5±1.1）d与对照组比较差异有统计学意义（t=6.983、10.588、5.783、4.315、4.011，P<0.05）。两组均未发生严重并发症。 结论 腹腔镜胆总管探查取石效果显著显著优于开腹胆总管探查取石，腹腔镜胆总管探查取石属于微创手术，不仅缩短患者手术时间，减少出血量，还促进患者肠功能恢复，缩短住院时间，值得临床推广。

[关键词] 腹腔镜;胆总管探查取石;开腹;临床分析

[中图分类号] R758          [文献标识码] A          [文章编号] 1674-0742（2018）12（c）-0060-03

[Abstract] Objective To study the clinical comparison of calculus removal by the laparoscopic common bile duct exploration and open common bile duct exploration. Methods 128 cases of patients with cholecystolithiasis and choledocholithiasis admitted and treated in our hospital from April 2014 to April 2018 were convenient selected and randomly divided into two groups with 64 cases in each， the control group used the open common bile duct exploration for removing stones， while the research group used the laparoscopic common bile duct exploration for removing stones， and the stone removal effect， operation time， intraoperative blood loss， bowel function recovery time， length of stay and time to get out of bed were compared between the two groups. Results The difference in the stone retrieval rate between the research group and the control group was not statistically significant， which was 98.44% in the research group（χ2=0.183， P>0.05）， and the operation time， intraoperative bleeding amount， recovery time of bowel function， length of stay， and time to get out of bed in the research group were respectively （60.4±14.6） min， （58.3±7.3） mL， （16.2±2.2） h， （5.0±1.1） d and （3.5±1.1） d， and the differences between the two groups were statistically significant（t=6.983， 10.588， 5.783， 4.315， 4.011， P< 0.05）， without serious complications. Conclusion The effect of stone removal of laparoscopic common bile duct exploration is obviously better than that of open common bile duct exploration， and the laparoscopic common bile duct exploration belongs to the minimally invasive surgery， which can not only shorten the operation time and reduce the bleeding amount， but also promote the recovery of bowel function， and shorten the length of stay， and it is worth clinical promotion.

[Key words] Laparoscopic;Choledocholithotomy;Laparotomy; Clinical analysis

胆总管结石在临床为常见胆道疾病，患者多合并胆囊结石，传统方法多采取开腹胆总管探查取石，对患者进行胆囊切除，胆总管切开取石并行T管引流处理，均属于侵入性操作，具有胆道渗漏风险，对患者形成一定的损伤，不利于康复[1-2]。随着微创技术的不断发展，腹腔镜技术广泛应用于临床，具有一定的优势，而腹腔镜胆总管探查取石也成为首选的治疗方法，为进一步探析胆囊结石合并胆总管结石以腹腔镜胆总管探查取石与开腹胆总管探查取石的临床对照，该文将2014年4月—2018年4月期间收治的128例胆囊结石合并胆总管结石患者，纳入研究对象，现报道如下。

1  资料与方法

1.1  一般资料

方便选取该院收治的128例胆囊结石合并胆总管结石患者，术前均经过磁共振胰胆管造影术得到证实。将其……