腹腔镜联合胆道镜胆管切开取石术在肝内外胆管结石中的应用效果
[摘要]目的 探讨腹腔镜联合胆道镜胆管切开取石术在肝内外胆管结石中的应用效果。方法 回顾性分析2014年1月～2018年12月辽阳市中心医院普外科收治的60例肝内外胆管结石患者的临床资料，并根据手术方案的不同，将其分为对照组(31例)和研究组(29例)。对照组患者采用传统开腹术治疗，研究组患者采用腹腔镜联合胆道镜胆管切开取石术治疗。比较两组患者的手术操作时间、术中总出血量、术后肛门排气时间以及住院总时间;根据视觉模拟量表(VAS)评分评估两组患者术后12、24、48及72 h的疼痛度;统计两组患者的术后并发症总发生率。结果 研究组患者的手术操作时间、术后肛门排气时间以及住院总时间均短于对照组，差异有统计学意义(P<0.05);研究组患者的术中总出血量少于对照组，差异有统计学意义(P<0.05);研究组患者术后12、24、48、72 h的VAS评分均低于对照组，差异有统计学意义(P<0.05);两组患者术后48、72 h的VAS评分均低于本组术后12 h，差异有统计学意义(P<0.05);研究组患者的并发症总发生率为10.34%，与对照组的22.58%比较，差异无统计学意义(P>0.05)。结论 腹腔镜联合胆道镜胆管切开取石术治疗肝内外胆管结石，能显著缩短手术时间、术后肛门排气时间和住院总时间，出血量少，疼痛感更弱，值得临床应用。
[关键词]肝内外胆管结石;腹腔镜;胆道镜;胆管切开取石术
[中图分类号] R657.42 [文獻标识码] A [文章编号] 1674-4721(2020)2(a)-0086-04
Application effect of laparoscope combined with choledochoscope common bile duct lithotomy on intrahepatic and extrahepatic bile duct stones
PAN Wen-jun
Department of General Surgery， Liaoyang Central Hospital， Liaoning Province， Liaoyang 111000， China
[Abstract] Objective To explore application effect of laparoscope combined with choledochoscope common bile duct lithotomy on intrahepatic and extrahepatic bile duct stones. Methods The clinical data of 60 patients with intrahepatic and extrahepatic bile duct stones admitted to the Department of General Surgery of Liaoyang Central Hospital from January 2014 to December 2018 were retrospectively analyzed. They were divided into control group (31 cases) and study group (29 cases) according to different surgical plans. The control group was treated with traditional laparotomy， while study group was treated with laparoscope combined with choledochoscope common bile duct lithotomy. The operation time， total intraoperative blood loss， postoperative anal exhaust time and total hospitalization time were compared between the two groups. The visual analogue scale (VAS) score was performed to evaluate pain degree in both groups at 12， 24， 48 and 72 h after surgery. The total incidence of postoperative complications in both groups was statistically analyzed. Results The operation time， postoperative anal exhaust time and total hospitalization time in study group were shorter than those in control group， the differences were statistically significant (P<0.05)， and total intraoperative blood loss was lower than that in control group， the difference was statistically significant (P<0.05). At 12， 24， 48， 72 h after surgery， the VAS scores in study group were lower than those in control group， the differences were statistically significant (P<0.05). The VAS scores of the two groups at 48 and 72 h after surgery were lower than that at 12 h after surgery， with statistically significant differences (P<0.05). The total incidence of complications in the study group was 10.34%， compared with 22.58% in the control group， the difference was not statistically significant (P>0.05). Conclusion Laparoscope combined with choledochoscope common bile duct lithotomy in treatment of intrahepatic and extrahepatic bile duct stones can significantly shorten operation time， postoperative anal exhaust time and total hospitalization time， the blood loss is little， and pain is weaker， it is worthy of clinical application, http://www.100md.com(潘文君)
[关键词]肝内外胆管结石;腹腔镜;胆道镜;胆管切开取石术
[中图分类号] R657.42 [文獻标识码] A [文章编号] 1674-4721(2020)2(a)-0086-04
Application effect of laparoscope combined with choledochoscope common bile duct lithotomy on intrahepatic and extrahepatic bile duct stones
PAN Wen-jun
Department of General Surgery， Liaoyang Central Hospital， Liaoning Province， Liaoyang 111000， China
[Abstract] Objective To explore application effect of laparoscope combined with choledochoscope common bile duct lithotomy on intrahepatic and extrahepatic bile duct stones. Methods The clinical data of 60 patients with intrahepatic and extrahepatic bile duct stones admitted to the Department of General Surgery of Liaoyang Central Hospital from January 2014 to December 2018 were retrospectively analyzed. They were divided into control group (31 cases) and study group (29 cases) according to different surgical plans. The control group was treated with traditional laparotomy， while study group was treated with laparoscope combined with choledochoscope common bile duct lithotomy. The operation time， total intraoperative blood loss， postoperative anal exhaust time and total hospitalization time were compared between the two groups. The visual analogue scale (VAS) score was performed to evaluate pain degree in both groups at 12， 24， 48 and 72 h after surgery. The total incidence of postoperative complications in both groups was statistically analyzed. Results The operation time， postoperative anal exhaust time and total hospitalization time in study group were shorter than those in control group， the differences were statistically significant (P<0.05)， and total intraoperative blood loss was lower than that in control group， the difference was statistically significant (P<0.05). At 12， 24， 48， 72 h after surgery， the VAS scores in study group were lower than those in control group， the differences were statistically significant (P<0.05). The VAS scores of the two groups at 48 and 72 h after surgery were lower than that at 12 h after surgery， with statistically significant differences (P<0.05). The total incidence of complications in the study group was 10.34%， compared with 22.58% in the control group， the difference was not statistically significant (P>0.05). Conclusion Laparoscope combined with choledochoscope common bile duct lithotomy in treatment of intrahepatic and extrahepatic bile duct stones can significantly shorten operation time， postoperative anal exhaust time and total hospitalization time， the blood loss is little， and pain is weaker， it is worthy of clinical application, http://www.100md.com(潘文君)