腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石临床疗效观察

高锦科1，刘英2 *

（陕西省榆林市定边县人民医院：1.普外科；2.内科，陕西 榆林，718699）

浏览次数：109次 下载次数：333次

摘要：

目的 观察腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床效果。方法 选取定边县人民医院普外科收治的胆 囊结石合并胆总管结石患者120 例，根据治疗方法不同分为A、B、C 组。A 组采用开腹胆囊切除+胆总管探查取石+T 管引流 术，B 组采用腹腔镜胆囊切除+胆总管探查术，C 组采用内镜下十二指肠乳头括约肌切开术+腹腔镜胆囊切除术。比较三组的 手术情况、术后并发症发生情况、结石清除情况及复发情况。结果 B、C 组术中出血量、下床活动时间、肛门排气时间、手术时 间、住院时间均优于A 组（P<0.05）；三组患者结石清除率比较，差异无统计学意义（P>0.05）；B、C 组复发率显著低于A 组（P<0.05），B、C 组复发率比较，差异无统计学意义（P>0.05）；三组患者并发症总发生率比较，差异无统计学意义（P>0.05）。结论 采用腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石清除率高，复发率低，术中出血量少，可显著缩短住院时间，减少术后 并发症发生率，值得临床推广应用。

关键词：腹腔镜；胆道镜；胆囊结石；胆总管结石

中图分类号：R657.4文献标志码：A文章编号：2096-1413(2018)01-0059-02

Clinical effect observation of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and choledocholithiasis
GAO Jin-ke 1, LIU Ying2 *
（1. General Surgery Department; 2. Internal Medicine Department, the People``s Hospital of Dingbian County, Yulin 718699, China）

ABSTRACT: Objective To observe the clinical effect of laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and choledocholithiasis. Methods A total of 120 patients with cholecystolithiasis and choledocholithiasis admitted in general surgery department of the People``s Hospital of Dingbian County were selected and divided into group A, group B and group C according to different treatment methods. The group A was treated with open cholecystectomy and common bile duct exploration and T -tube drainage, the group B was treated with laparoscopic cholecystectomy and common bile duct exploration, the group C was treated with endoscopic duodenal sphincterotomy and laparoscopic cholecystectomy. The surgical conditions, postoperative complications, stones removal and recurrence were compared among the three groups. Results The amount of intraoperative bleeding, time of getting out-of-bed, anal exhaust time, operation time and hospital stay of the group B and group C were better than those of the group A (P<0.05). There was no significant difference in the stone clearance rate among the three groups (P>0.05). The recurrence rates of the group B and group C were lower than that of the group A (P<0.05), and there was no significant difference between the group B and group C (P> 0.05). There was no significant difference in the total incidence of complications among the three groups (P >0.05). Conclusion Laparoscopy combined with choledochoscopy in the treatment of cholecystolithiasis and choledocholithiasis has high stone clearance rate, low recurrence rate, less amount of intraoperative blood, which can significantly shorten the hospital stay, reduce the incidence of postoperative complications, and is worthy of clinical promotion and application.
KEYWORDS: laparoscopy; choledochoscopy; cholecystolithiasis; choledocholithiasis

参考文献：
[1] 孙科,肖宏,陈安平,等.腹腔镜下经胆囊管逆向乳头插管法治疗胆囊结石合并细径胆总管结石的临床疗效[J].中华消化外科杂志,2016,15(4):363-367.
[2] 石玉琪,许春芳.ERCP 联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石术后胆总管结石复发的危险因素分析[J].中华消化内 镜杂志,2016,33(10):689-692.
[3] 杨星,刘巍,邓小明,等.术前MRCP 与LC 术中胆道造影诊断胆囊 结石合并可疑胆总管结石的临床价值比较[J].重庆医学,2016,45(15):2070-2072.
[4] 王宾,刘振杰,吕云霄,等.术前与术中内镜下括约肌切开术治疗胆囊结石合并胆总管结石的荟萃分析[J].中华医学杂志,2015,95(18):1425-1429.
[5] 沈旦,郭庆渠,吴育连.腹腔镜联合十二指肠镜不同序贯次序治疗胆囊结石并胆总管结石效果对比研究[J].中国内镜杂志,2015,21(1):30-32.
[6] 徐中英,赖良,张国平.双镜联合治疗胆囊结石合并胆总管结石并发症的观察及护理[J].中国实用护理杂志,2015,31(6):423-425.
[7] 刘志毅,金虎,李亚刚,等.LC+EST 一期治疗胆囊结石合并胆总管结石[J].中华普通外科杂志,2015,30(7):541-543.
[8] 菅志远,沈先锋,黄林生,等.三种微创方式治疗胆囊结石合并胆总管结石的临床疗效分析[J].中国普通外科杂志,2015,24(2):275-279.