目的探讨腹腔镜联合胆道镜治疗胆囊及胆总管结石的临床疗效。 方法回顾性分析2010年1月至2013年1月期间收治于笔者所在科室的96例胆囊及胆总管结石患者的临床资料，根据手术方式分为开腹组、腹腔镜联合胆道镜＋T管引流术组和腹腔镜联合胆道镜＋放置鼻胆管一期缝合组3组。对3组患者的手术时间、术中出血量、肛门排气时间、住院时间、残石率、复发率、并发症发生率、手术有效率及术后淀粉酶和肝功能指标水平进行对比分析。 结果微创手术组与开腹组比较，患者的出血量、肛门排气时间、住院时间、残石率、复发率及并发症发生率均减少、缩短或降低，同时手术的有效率提高（P＜0.05）；腹腔镜联合胆道镜＋放置鼻胆管一期缝合组术后淀粉酶和肝功能指标的水平较其他2组明显降低（P＜0.05）。 结论微创手术创伤小，残石率及复发率低，并发症少，患者术后恢复快，是一种安全有效的治疗方式，值得临床推广应用。
Objective To evaluate effectiveness and safety of electronic choledochoscopy in treatment of intrahepatic bile duct stones. Methods From July 2013 to February 2016, 280 patients with intrahepatic bile duct stones in the Department of General Surgery of the Affiliated Hospital of Shandong Academy of Medical Sciences were selected as the research objects. All the patients were randomly divided into a choledochoscopy treatment group and a conventional treatment group by envelope principle method. There were 140 patients in each group. The safety and short- and long-term effectiveness were compared in these two groups. This study was approved by the ethics committee of the hospital. Results ① The age, gender, body mass index, course of disease, and location of stone had no significant differences in these two groups (P>0.05). ② The operations and the net stones were successfully completed in all the patients. The operative time was shorter, the blood loss was less, the incision length was smaller, the postoperative anal exhaust time was earlier, and the hospitalization time was shorter in the choledochoscopy treatment group as compared with the conventional treatment group (P<0.05). ③ The total postoperative complication rate on day 14 in the choledochoscopy treatment group was 2.9% (4/140), which was significantly lower than that in the conventional treatment group (11.4%, 16/140, P<0.05). ④ The curative excellent and good rates was 97.9% and 85.0% in the choledochoscopy treatment group and conventional treatment group respectively, which was a significant difference in these two groups (P<0.05). ⑤ The postoperative serum ALT and AST values on month 6 in the choledochoscopy treatment group were significantly lower than those in the conventional treatment group (P<0.05). Conclusion Electronic choledochoscopy in treatment of intrahepatic bile duct stones could promote rehabilitation of patient, reduce incidence of postoperative complications, and it is conducive to promoting recovery of liver function and improving follow-up effect.
目的 探讨纤维胆道镜在胆道探查术中及术后的应用价值。方法 对113例在胆道探查术中及术后应用纤维胆道镜治疗患者的疗效进行回顾性分析。结果 23例胆总管扩张合并黄疸且术前未见结石的患者，其中19例术中胆道镜发现结石并于术中取净结石，2例炎性狭窄，1例胆管癌，1例未见异常。58例胆总管结石患者术中胆道镜取净结石。32例肝内、外胆管结石患者术中胆道镜取净结石21例; 2例胆道镜发现结石集中于肝左外叶合并肝内胆管狭窄, 行肝左外叶切除; 其余9例患者的结石术中未取净，于术后6～8周再经胆道镜T管窦道取净结石。113例患者术后均无严重并发症发生。术后获随访98例（86.7%），随访时间6～24个月，平均14个月，2例复发，其余96例未见结石复发。结论术中应用纤维胆道镜可明确胆管内病变，降低胆管残余结石的发生率; 术后经T管窦道取石是治疗胆管残余结石的有效方法，可避免再次手术的痛苦。
ObjectiveTo explore the clinical efficacy and surgical techniques of laparoscopic choledocholithotomy and primary suture. MethodsWe retrospectively analyzed the clinical data of 58 patients who underwent laparoscopic choledocholithotomy and primary suture between January 2009 and December 2014. ResultsAll the 58 patients underwent the surgery successfully. Operation time was 45-125 minutes, averaging 75 minutes. Intraoperative blood loss was between 10 and 50 mL with an average of 20 mL. Postoperative hospital stay was 5-14 days with an average of 7 days. Four cases of biliary leakage were cured by conservative treatment. ConclusionWith operation indications strictly grasped and skillful operation techniques, laparoscopic choledocholithotomy and primary suture are safe and reliable with a good curative effect.
目的:总结应用腹腔镜联合胆道镜治疗胆总管结石的体会。方法:回顾分析2003年1月至2009年5月成都市第五人民医院联合应用腹腔镜胆道镜治疗胆总管结石的临床资料。结果:经胆囊颈管取石成功21例,切开胆总管取石27例,其中胆总管I期缝合17例,T管引流31例,3例术后发生胆总管残余结石,经T管窦道胆道镜取石治愈,5例中转开腹。结论:选择合适病例,腹腔镜联合胆道镜治疗胆总管结石患者创伤小,效果好,且安全可靠。
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
目的 减少肝内胆管结石术后的残留。方法 回顾性分析近5年我科收治的50例肝内胆管结石病例行病灶肝切除并结合术中、术后胆道镜应用的近期疗效及术后残石率。结果 术后近期并发症发生率为8%，无胆漏、肝衰及手术死亡发生，术后B超、逆行T管造影及术后胆道镜检查证实的即期残石率仅4%（2例）。结论 减少肝内胆管结石术后结石残留的关键是术中术后胆道镜的使用，肝内及肝门胆管狭窄的彻底处理； 依据狭窄胆管所引流区域行“根治性”的肝组织切除是取尽结石，清除病灶的合理方法。