陈松

[摘要] 目的 探讨在治疗胆总管巨大结石过程中，联合使用腹腔镜胆总管切开和钬激光碎石方法的臨床疗效，为促进患者在术后短时间内恢复提供良好的基础条件。 方法 随机选取该院2013年1月—2017年4月入院的胆总管巨大结石患者作为研究样本，分别设置对照组和观察组，每组114例，对照组单纯采用腹腔镜胆总管切除术，观察组患者联合使用腹腔镜胆总管切开术和钬激光碎石术，采用腹腔镜胆总管切开术对直径<2 cm的结石切除，针对直径≥2 cm的结石，采用钬激光碎石术。 结果 观察组患者的手术时间为（56.34±0.47）min，住院时间为（6.54±0.21）d，胃肠功能恢复时间为（3.24±0.17）d，术后疼痛时间为（10.45±1.02）h。患者的手术治疗成功率为98.25%（112/114），结石完全清除率99.12%（113/114）以及结石残余率0.78%（1/114）。患者于治疗后的生活质量评分显著优于治疗前（P<0.05）。结论 应将腹腔镜胆总管切开术联合钬激光碎石术作为治疗胆总管巨大结石的首选方法，实现对结石的全部碎除，提升治疗的安全性。

[关键词] 腹腔镜；钬激光；胆总管巨大结石；成功碎石率

[中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2018）08（a）-0054-03

Laparoscopic Common Bile Duct Incision Combined with Holmium Laser in the Treatment of Huge Stones in Common Bile Duct

CHEN Song

Department of General Surgery， Fenjinting Hospital， Sihong， Jiangsu Province， 223900 China

[Abstract] Objective To explore the clinical efficacy of combined use of laparoscopic common bile duct incision and holmium laser lithotripsy in the treatment of huge stones in the common bile duct， which provides a good basic condition for the recovery of patients within a short time after surgery. Methods The patients with huge common bile duct stones admitted to the hospital from January 2013 to April 2017 were randomly selected as study samples. Control and observation groups were set up respectively，with 114 cases in each group. The control group was treated with laparoscopic common bile duct resection only. Patients were treated with laparoscopic common bile ductotomy and holmium laser lithotripsy. Laparoscopic common bile duct incision was used to remove stones less than 2 cm in diameter. Holmium laser lithotripsy was used for stones with a diameter of 2 cm or more. Results In the observation group， the operation time was（56.34±0.47） min， the length of hospital stay was （6.54±0.21）days， the recovery time of gastrointestinal function was（3.24±0.17） hours， and the postoperative pain time was （10.45±1.02）hours. The success rate of surgical treatment was 98.25%（112/114）， the complete stone clearance rate was 99.12% （113/114）， and the stone residual rate was 0.78% （1/114）. The patient's quality of life score after treatment was significantly better than before treatment （P<0.05）. Conclusion Laparoscopic common bile ductotomy combined with holmium laser lithotripsy should be the first choice for the treatment of huge stones in the common bile duct. All stones should be removed and the safety of treatment should be improved.

[Key words] Laparoscopy； Holmium laser； Giant bile duct stones； Successful stone rate

胆总管巨大结石是临床中的常见疾病类型，胆总管巨大结石的发病率与患者的年龄具有十分密切的关系，患者年龄的增长，结石的发病率也随之增长。受巨大结石阻塞胆道的影响，患者会表现为剧烈疼痛、黄疸和持续高热的症状。现阶段，临床治疗胆总管巨大结石的过程中，采用腹腔镜胆总管切开术只能取出直径小于2 cm的结石，针对直径较大的结石，还需使用钬激光碎石术[1]。该次研究分别随机选取该院2013年1月—2017年4月入院的胆总管巨大结石患者作为研究样本，主要探析了钬激光碎石术和腹腔镜胆总管切开方法联合使用对胆总管巨大结石的治疗效果，现报道如下。

1 资料与方法

1.1 一般资料

随机选取该院的114例胆总管巨大结石患者作为观察组，男性38例，女性76例，年龄：22～88岁，平均年龄（56.48±1.06）岁。选择该院同期收治的114例胆总管巨大结石患者作为对照组，其年龄与性别与观察组具有一致性。……