膽道鏡聯合腹腔鏡手術治療原發性肝膽管結石療效觀察

姜奕楊

[摘要] 目的 探討運用膽道鏡聯合腹腔鏡手術治療原發性肝膽管結石的臨床療效。 方法 選取2015年1月～2016年12月期間我院205例原發性肝膽管結石患者，按手術方式不同將其分為研究組、常規組，其中研究組103例，常規組102例。研究組采用膽道鏡聯合腹腔鏡手術進行治療，常規組行傳統開腹術，對比兩組手術相關指標、VAS評分及并發癥發生率。 結果 研究組與常規組術中出血量、肛門排氣時間、下床活動時間、住院時間等相關指標對比均有統計學差異（t=-13.649、-17.290、-12.471、-8.779，P<0.05）；研究組與常規組術前VAS評分比較差異無統計學意義（t=-0.717，P=0.474），研究組術后VAS評分顯著低于常規組，組間對比具有統計學差異（t=-4.807，P=0.000）；研究組術后并發癥發生率為3.88%，顯著低于常規組的12.75%，組間對比具有統計學意義（χ2=5.160，P=0.023）。 結論 相較于傳統開腹術，運用膽道鏡聯合腹腔鏡治療原發性肝膽管結石手術效果更優，有利于減少術中出血量，促進術后肛門排氣，減輕術后疼痛程度，降低并發癥發生率，縮短患者住院時間，進一步促進術后康復，具備臨床意義與實施價值。

[關鍵詞] 膽道鏡；聯合；腹腔鏡手術；原發性肝膽管結石

[中圖分類號] R657.4 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0052-03

[Abstract] Objective To investigate the clinical efficacy of cholangioscopy combined with laparoscopic surgery in the treatment of primary hepatolithiasis. Methods Totally 205 patients with primary hepatolithiasis in our hospital from January 2015 to December 2016 were divided into study group（n=103） and conventional group（n=102） according to the different surgical methods. The study group was treated with cholangioscopy combined with laparoscopic surgery. The conventional group underwent traditional laparotomy. The surgery-related indicators， VAS score and complication rate between the two groups were compared. Results There were statistically significant differences in the related indicators including intraoperative blood loss， anal exhaust time， ambulation time and hospital stay between the study group and conventional group（t=-13.649， -17.290， -12.471， 8.779， P<0.05）. There was no statistically significant difference in the VAS score between the study group and the conventional group before surgery（t=-0.717， P=0.474）. The postoperative VAS score in the study group was significantly lower than that of the conventional group， and the difference between the two groups was significant（t=-4.807， P=0.000）. The postoperative complication rate in the study group was 3.88%， which was significantly lower than that in the conventional group（12.75%， χ2=5.160， P=0.023）. There was statistical significance between groups. Conclusion The surgical effect of cholangioscopy combined with laparoscopy in the treatment of primary hepatolithiasis is better than that of the traditional open surgery. And cholangioscopy combined with laparoscopy will help reduce the amount of bleeding during operation， promote postoperative anal exhaust， reduce postoperative pain and reduce complications rate， shorten hospital stay， and further promote postoperative recovery， which has clinical significance and implementation value.

[Key words] Cholangioscopy； Union； Laparoscopic surgery； Primary hepatolithiasis

肝膽管結石屬于臨床多發疾病，且并發癥發生率及疾病復發率均較高，對人們的生理及心理健康造成不同程度影響，同時降低生活質量[1]。原發性肝膽管結石主要是指發生于左右肝管匯合部位的結石，還包括各個分支肝管結石，其中以膽紅素結石發生率較高[2]。隨著微創理念的不斷發展，內鏡技術已廣泛運用于臨床各個領域，采用腹腔鏡聯合膽道鏡實施肝膽管結石手術可起到優勢互補作用，進一步提升手術效果，具有創傷小、出血量少、術后并發癥少、術后康復快等優勢。此外，手術作為應激源的一種，可導致患者生理及心理均產生不同程度的應激反應，直接影響手術效果及術后康復[3]。本文選取2015年1月～2016年12月期間我院205例原發性肝膽管結石患者，探討兩種不同術式治療原發性肝膽管結石的臨床療效，現報道如下。……