李含拓 任志刚

[摘要] 目的 探讨腹腔镜联合胆道镜在胆总管探查取石術中的应用效果。 方法 该研究回顾性分析2014年1月—2018年1月该院因胆总管结石接受手术治疗的98例患者资料，根据手术方法将其分为腔镜组49例和剖腹组49例。剖腹组采用传统的剖腹探查术，腔镜组行腹腔镜胆囊切除术。比较两组手术时间、术中出血量、腹腔引流量、术后胃肠功能恢复时间、住院时间、切口感染率。同时，随访1年，对比两组胆管残留与胆管狭窄的发生率。结果 剖腹组手术时间（121.5±35.5）min、术中出血量（110.5±15.5）mL、腹腔引流量（60.2±17.3）mL、术后胃肠功能恢复时间（80.5±17.3）h、住院时间（14.2±1.8）d均高于腔镜组（90.5±15.8）min、（40.5±11.8）mL、（30.2±15.8）mL、（48.5±5.8）h、（7.2±1.2）d（t=9.546、11.526、8.526、7.856、7.526，P<0.05）。腔镜组术后无切口感染病例，剖腹组术后出现切口感染6例，腔镜组术后切口感染率0.00%低于对剖腹组12.24%（χ2=4.438，P<0.05）。术后随访1年，两组患者均行常规行肝功能、B超、CT或MRCP检查，未见胆管残留结石和胆管狭窄。结论  腹腔镜联合胆道镜在胆总管探查取石术中具有显著的应用效果，能够加快患者的康复速度，降低感染概率，值得临床推广。

[关键词] 腹腔镜;胆道镜;胆总管探查取石术

[中图分类号] R5          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0035-03

Application of Laparoscopic Combined with Choledochoscopy in Common Bile Duct Exploration and Stone Removal

LI Han-tuo， REN Zhi-gang

Department of General Surgery， Changping District Hospital， Beijing， 102200 China

[Abstract] Objective To investigate the effect of laparoscopic combined with choledochoscopy in the exploration of common bile duct exploration. Methods This study retrospectively analyzed the data of 98 patients who underwent surgery for choledocholithiasis from January 2014 to January 2018. According to the surgical method， they were divided into 49 cases of laparoscopic group and 49 cases of laparotomy group. The laparotomy group underwent conventional laparotomy and the laparoscopic group underwent laparoscopic cholecystectomy. The operation time， intraoperative blood loss， abdominal drainage volume， postoperative gastrointestinal function recovery time， hospitalization time， and incision infection rate were compared between the two groups. At the same time， follow-up was performed for 1 year， and the incidence of bile duct residual and bile duct stenosis was compared between the two groups. Results The operation time of laparotomy group （121.5±35.5） min， intraoperative blood loss （110.5±15.5）mL， abdominal drainage volume （60.2±17.3） mL， postoperative gastrointestinal function recovery time （80.5±17.3）h， hospitalization time （14.2±1.8）d were higher than the laparoscopic group （90.5±15.8） min， （40.5±11.8）mL， （30.2±15.8）mL， （48.5±5.8）h， （7.2±1.2）d （t=9.546， 11.526， 8.526， 7.856， 7.526， P<0.05）. There were no incision infections in the laparoscopic group. Six cases of wound infection occurred in the laparotomy group. The incision infection rate of the laparoscopic group was 0.00% lower than that of the laparotomy group （12.24%， χ2=4.438， P<0.05）. All patients were followed up for 1 year. All patients underwent routine liver function， B-ultrasound， CT or MRCP examination. No residual bile duct stones and bile duct stricture were found. Conclusion Laparoscopic combined with choledochoscopy has significant application effects in common bile duct exploration and stone removal. It can speed up the recovery of patients and reduce the probability of infection， which is worthy of clinical promotion.

[Key words] Laparoscopic; Choledochoscopy; Common bile duct exploration and stone removal

胆石症是一种常见病、多发病，临床工作中胆总管结石的患者很常见，且多数患者为胆总管结石合并胆囊结石，目前治疗胆总管结石仍以手术治疗为主，其治疗目的是取净胆总管结石、解除胆道梗阻、通畅引流[1]。多年来传统术式是胆囊切除术，胆总管切开、取石，T 管引流术，随着腹腔镜技术的发展，目前胆囊伴胆总管结石的首选治疗方式就是腹腔镜，其安全性、有效性与开腹手术基本一致，同时创伤更小[2]。该研究回顾性方便选择2014年1月—2018年1月该院49例胆总管结石患者应用腹腔镜联合胆道镜行胆总管探查取石术，疗效较满意，现报道如下。

1  资料与方法

1.1  一般资料

该研究回顾性分析该院因胆总管结石接受手术治疗的98例患者资料，根据手术方法将其分为腔镜组49例和剖腹组49例。……