腹腔镜联合胆道镜在胆囊结石合并胆总管结石治疗中应用.docVIP

腹腔镜联合胆道镜在胆囊结石合并胆总管结石治疗中应用 　　【摘要】 目的：探讨腹腔镜联合纤维胆道镜双镜治疗胆囊结石合并胆总管结石的临床疗效。方法：选取2014年1月-2015年12月江苏大学附属武进医院普外科行手术治疗胆总管结石患者60例，其中行腹腔镜联合胆道镜治疗30例作为腔镜组，开腹手术治疗30例作为开腹组，观察并比较两组临床疗效结果。结果：60例手术均获成功，腔镜组在术中出血量、胃肠功能恢复时间、住院天数、术后切口感染发生率方面均优于开腹组（P0.05）。结论：腹腔镜和胆道镜双镜联合治疗胆总管结石具有损伤小、恢复快、术中出血少、住院时间短及术后并发症少等优点，是目前治疗胆道结石较理想的微创术式，临床上值得推广。 　　【关键词】 腹腔镜； 胆道镜； 胆总管探查术； 开腹手术 　　【Abstract】 Objective：To observe the experience of laparoscope joint choledochoscope in treatment of cholecystolithiasis combined with choledocholithiasis.Method：The clinical data of 60 patients with cholecystolithiasis combined with choledocholithiasis were divided into laparoscopic group of 30 cases and laparotomy group of 30 cases， which were treaded in our hospital from January 2014 to December 2015.Result：60 patients were successfully completed.The intraoperative blood loss，gastrointestinal function recovery time，hospitalization time and incision infection rate in the laparoscopic group were better than those of laparotomy group，the differences were statistically significant（P0.05）.Conclusion：Laparoscope joint choledochoscope in treatment of cholecystolithiasis combined with choledocholithiasis has such advantages as less trauma，rapid recovery，less intraoperative bleeding，shorter hospitalization time and lower postoperative complications rate compared with traditional open surgical method. 　　【Key words】 Laparoscope； Choledochoscope； Choledochotomy； Laparotomy 　　First-author’s address：Jiangsu University Affiliated Wujin Hospital，Changzhou 213002，China 　　doi：10.3969/j.issn.1674-4985.2017.01.007 　　?囊结石是普外科的常见病、多发病，相关文献[1]报道有4%～15%胆囊结石合并胆总管结石。随着腔镜技术的迅猛发展，胆囊结石合并胆总管结石的治疗方法趋于微创化。根据不同的情况，70%～90%胆总管结石可应用微创技术治疗，且治疗成功率可达97.79%[2]。如今胆囊结石合并胆总管结石的治疗方案多样，包括传统开腹手术、腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）+经十二指肠镜逆行胰胆管造影（endoscope retrograde cholangiopancreatography，ERCP）+内镜下乳头括约肌切开术（endoscopic sphincterotomy，EST）、腹腔镜胆囊切除术+两镜（胆道镜及腹腔镜）联合胆总管探查术、腹腔镜胆囊切除术+三镜（十二指肠镜、胆道镜及腹腔镜）联合胆总管探查术等，且各手术方式的临床疗效及并发症各有不同[3]。本文通过对照研究，分析腹腔镜联合胆道镜对比开腹手术两种不同方法治疗