CAJ | 학술논문

目的探讨FREDDY激光碎石术在腹腔镜联合胆道镜治疗难取性中央型胆管结石中的临床疗效.方法腹腔镜联合胆道镜治疗难取性中央型胆管结石55例患者,根据治疗方法不同分为两组,FREDDY组31例,常规组24例.比较两组的手术时间、术中出血量、中转开腹率、术后肛门排气时间、术后严重并发症发生率(如胰腺炎、胆道出血、胆漏)、术后住院时间、一期结石清除率等指标.结果 FREDDY组的手术时间、术中出血量、术后肛门排气时间、术后住院时间分别为( 106.2±49.4) min、( 37.7±28.6) ml、(25.8±19.3)h、(5.9±3.3)d,与常规组的(142.2±64.8) min、(60.3±32.1) ml、( 37.2±21.6)h、(8.4±4.9)d比较差异有统计学意义(P＜0.05或＜0.01)；两组中转开腹率、术后严重并发症发生率、一期结石清除率比较差异无统计学意义(P＞0.05).两组均无死亡病例,术后胆管残留结石7例患者均于术后6周经T管窦道行胆道镜取石术而治愈.43例患者术后随访6～ 12个月,未发现结石复发、胆管狭窄.结论腹腔镜联合胆道镜FREDDY激光碎石术治疗难取性中央型胆管结石具有微创、安全、高效、并发症少的特点,近期疗效佳.
목적 탐토FREDDY격광쇄석술재복강경연합담도경치료난취성중앙형담관결석중적림상료효.방법 복강경연합담도경치료난취성중앙형담관결석55례환자,근거치료방법불동분위량조,FREDDY조31례,상규조24례.비교량조적수술시간、술중출혈량、중전개복솔、술후항문배기시간、술후엄중병발증발생솔(여이선염、담도출혈、담루)、술후주원시간、일기결석청제솔등지표.결과 FREDDY조적수술시간、술중출혈량、술후항문배기시간、술후주원시간분별위( 106.2±49.4) min、( 37.7±28.6) ml、(25.8±19.3)h、(5.9±3.3)d,여상규조적(142.2±64.8) min、(60.3±32.1) ml、( 37.2±21.6)h、(8.4±4.9)d비교차이유통계학의의(P＜0.05혹＜0.01)；량조중전개복솔、술후엄중병발증발생솔、일기결석청제솔비교차이무통계학의의(P＞0.05).량조균무사망병례,술후담관잔류결석7례환자균우술후6주경T관두도행담도경취석술이치유.43례환자술후수방6～ 12개월,미발현결석복발、담관협착.결론 복강경연합담도경FREDDY격광쇄석술치료난취성중앙형담관결석구유미창、안전、고효、병발증소적특점,근기료효가.
Objective To investigate the clinical efficacy of laparoscopy combined with cholangioscopic FREDDY laser lithotripsy for the treatment of difficult central type bile duct calculi.Methods Fifty-five patients with difficuh central type bile duct calculi undergoing laparoscopy combined with cholangioscopy were analyzed retrospectively.There were 31 patients in FREDDY laser lithotripsy group (FREDDY group) and 24 patients in routine instrunent group (routine group).Operative time,intraoperative blood loss,conversion rate,time to first flatus,incidence of postoperative complications (such as pancreatitis,hemobilia and biliary leak),postoperative hospital stay and first session bile duct clearance rate were compared.Results Operative time,intraoperative blood loss,time to first flatus,postoperative hospital stay in FREDDY group [( 106.2 ± 49.4) min,(37.7 ± 28.6) ml,(25.8 ± 19.3 ) h,(5.9 ± 3.3 ) d]were significantly lower than those in routine group[( 142.2 ± 64.8 ) min,(60.3 ± 32.1 ) ml,(37.2 ± 21.6 ) h,(8.4 ±4.9) d] (P＜ 0.05 or ＜0.01 ).There were no statistically significant differences in conversion rate,incidence of postoperative complications and first session bile duct clearance rate between the two groups (P ＞ 0.05).There were no dead in both groups.Seven patients with residual bile duct stones were cured by cholangioscopy through T-tube sinus 6 weeks after prior surgery.Forty-three patients were followed up 6 to 12 months with no recurrent bile duct stones and bile duct stenosis.Conclusions Laparoscopy combined with cholangioscopic FREDDY laser lithotripsy is recommendable to treating difficult central type bile duct calculi with good short-term results and has the advantages of minimal invasiveness,safety,efficiency and rare complications.