摘要
目的探讨联合腹腔镜、胆道镜治疗胆囊结石合并胆总管结石的临床应用价值。方法120例胆囊结石合并胆总管结石患者中56例经腹腔镜胆囊切除＋胆总管切开取石T管引流术（LCTD）；64例行开腹胆囊切除＋胆总管切开取石T管引流术。比较两组患者术后镇痛药使用、切口感染、胃肠道功能恢复情况及住院时间等。结果两组均未出现严重并发症。开腹组术后切口感染率为12．5％，平均住院（14．9±3．1）d，胃肠道功能恢复时间为（26．1±8．6）h；LCTD组未出现切口感染，平均住院（5．8±1．4）d，胃肠道功能恢复时间为（10．6±3．4）h；两组患者术后恢复情况比较差异有统计学意义（P〈0．05—0．01）。开腹组术后发现胆道残余结石，经胆道镜取出。随访1个月至3年，开腹手术组2例复发胆总管结石，LCTD组无结石复发。结论与传统开腹手术相比，LCTD具有创伤小、恢复快、住院时间短等优点，安全有效。可根据条件选择作为胆囊结石合并胆总管结石的微创治疗方法之一。
Objective To investigate the value of clinical use of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis. Methods Of 120 patients suffering from cholecystolithiasis combined with choledocholithiasis, 56 patients underwent laparoscopic cholecystectomy together with choledocholithotomy and T- tube drainage （LCTD）, and 64 patients received routine cholecystectomy and choledocholithotomy plus T-tube drainage by laparotomy. Postoperative administration of analgesics, wound infection, recovery of function of gastrointestinal tract （ RFGI ） , and hospital stay were compared between the two groups. Results In both groups, there were no severe complications. Wound infection rate was 12.5 % , average hospital stay was （14.9 ±3.1） d, and RFGI was （26. 1 ±8.6） h in routine operation group; while in LCTD group, there was no wound infection occurred, hospital stay was （ 5.8 ± 1.4 ） d and RFGI was （ 10.6 ± 3.4 ） h. There were significant difference in postoperative recovery conditions between the two groups （ P 〈 0. 05 - 0.01 ）. After 1 month to 3 years follow - up, 2 patients suffered from recurrence of choledocholithiasis in routine operation group. Conclusions Laparoscopic cholecystectomy together with choledocholithotomy and T-tube drainage, has the advantages of minimal invasion, quick recovery and short hospital stay with safe and effective outcomes, and, depending on the circumstances, can be selected as a therapeutic choice for cholecystolithiasis complicated with choledocholithiasis.
出处
《中国普通外科杂志》
CAS
CSCD
2008年第2期114-116,共3页
China Journal of General Surgery
关键词
胆结石/外科学
胆囊切除术/方法
胆总管结石
腹腔镜
胆道镜
Cholelithiasis/surg
Cholecystectectomy/methods
Choledocholithiasis
Laparoscopes
Choledochoecopy
