腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石治疗胆总管下段嵌顿结石的回顾性分析

摘要

Objective To study the clinical efficacy of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stones.Methods The medical records of 60 patients with distal common bile duct incarceration stones treated in our hospital from May 2013 to May 2016were collected and analyzed retrospectively.According to different surgical methods,the patients were divided into the laparoscopic group and the traditional open group,30 cases in each group.The laparoscopic group were treated by laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy while the open group were treated by open common bile duct exploration.The stress indexes,intraoperative indexes,postoperative recovery,complications and recurrence rate were compared between the two groups.Results The time for stone removal,intraoperative blood loss,anal exhaust time and hospital stay of the laparoscopic group [(7.87 ± 2.52) min,(36.41 ± 9.21) ml,(1.63 ±0.68) d,(10.86-± 2.53) d were significantly shorter than or less than those of the open group [(13.25 ± 3.67) min,(82.13 ± 24.75) ml,(2.60 ± 0.91) d,(15.77 ± 4.41) d (P ＜ 0.05).The stone residual rate,incision infection rate,the incidence of biliary fistula and stone recurrence rate in the laparoscopic group (3.3％,0.0％,3.3％,6.7％) were significantly lower than those in the open group (20.0％,13.3％,20.0％,26.7％) (P ＜ 0.05).Conclusion The application of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stonescan completely remove the stones,the damage to the body is reltively milder,and the postoperative complications are few,which is conducive to the recovery of patients after operation.%目的 研究腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石治疗胆总管下段嵌顿结石的临床疗效.方法 收集我院2013年5月至2016年5月60例胆总管下段嵌顿结石患者病历资料,进行回顾性分析.根据手术方式不同将患者分为腹腔镜组与传统开腹组,每组30例.腹腔镜组采用腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石,传统开腹组采用开腹胆总管切开取石.比较两组应激指标、术中指标、术后恢复情况、并发症与复发率.结果 腹腔镜组取石时间、术中出血量、肛门排气时间、住院时间分别为(7.87 ±2.52) min、(36.41 ±9.21) ml、(1.63 ±0.68)d、(10.86 ±2.53)d显著低于传统开腹组的(13.25 ±3.67) min、(82.13 ±24.75)ml、(2.60 ±0.91)d、(15.77 ±4.41) d(P ＜0.05),结石残留率、切口感染率、胆瘘发生率、结石复发率分别为3.3％、0.0％、3.3％、6.7％显著低于传统开腹组的20.0％、13.3％.20.0％、26.7％(P＜0.05).结论 腹腔镜下胆总管低位切开与腹腔镜钬激光治疗胆总管下段嵌顿结石,可以有效清除结石,对机体损伤较轻,术后并发症较少,有利于患者术后康复.