CAJ | 학술논문

目的：探讨基层医院腹腔镜结合胆道镜治疗肝外胆管结石的临床疗效。方法：2012年1月-2014年5月收治肝外胆管结石患者100例，根据治疗方法的不同分为试验组和对照组，每组50例。试验组采取腹腔镜结合胆道镜治疗肝外胆管结石，对照组行传统开腹手术治疗，比较分析两组的手术时间、术中出血量、术后住院天数、术后肠道功能恢复时间、术后疼痛、术后结石残余、胆瘘、切口感染等并发症的发生率。结果：手术时间：试验组(150.43±24.28)min，对照组(120.41±11.85)min(t=10.37，P＞0.05)；术中出血量：试验组(28.42±8.14)mL，对照组(87.16±14.06)mL(t=32.17，P＜0.05)；术后肠道功能恢复时间：试验组(37.30±3.79)h，对照组(72.14±5.38)h(t=35.22，P＜0.05)；术后住院天数：试验组(6.35±1.46)d，对照组(9.26±2.13)d(t=11.87，P＜0.05)；术后疼痛所占比例：试验组32.00%，对照组(54.00%)(χ2=27.54，P＜0.05)；术后胆瘘发生率：试验组为2.00%，对照组为16.00%(χ2=21.35，P＜0.05)；切口感染率：试验组为4.00%，对照组为20.00%(χ2=19.47，P＜0.05)；两组均无术后结石残余发生。结论：腹腔镜结合胆道镜治疗肝外胆管结石安全有效，具有创伤小、恢复快、术后疼痛轻、术后并发症少、住院时间短的特点，适合临床推广应用。
목적：탐토기층의원복강경결합담도경치료간외담관결석적림상료효。방법：2012년1월-2014년5월수치간외담관결석환자100례，근거치료방법적불동분위시험조화대조조，매조50례。시험조채취복강경결합담도경치료간외담관결석，대조조행전통개복수술치료，비교분석량조적수술시간、술중출혈량、술후주원천수、술후장도공능회복시간、술후동통、술후결석잔여、담루、절구감염등병발증적발생솔。결과：수술시간：시험조(150.43±24.28)min，대조조(120.41±11.85)min(t=10.37，P＞0.05)；술중출혈량：시험조(28.42±8.14)mL，대조조(87.16±14.06)mL(t=32.17，P＜0.05)；술후장도공능회복시간：시험조(37.30±3.79)h，대조조(72.14±5.38)h(t=35.22，P＜0.05)；술후주원천수：시험조(6.35±1.46)d，대조조(9.26±2.13)d(t=11.87，P＜0.05)；술후동통소점비례：시험조32.00%，대조조(54.00%)(χ2=27.54，P＜0.05)；술후담루발생솔：시험조위2.00%，대조조위16.00%(χ2=21.35，P＜0.05)；절구감염솔：시험조위4.00%，대조조위20.00%(χ2=19.47，P＜0.05)；량조균무술후결석잔여발생。결론：복강경결합담도경치료간외담관결석안전유효，구유창상소、회복쾌、술후동통경、술후병발증소、주원시간단적특점，괄합림상추엄응용。
Objective:To investigate the clinical efficacy of laparoscopy combined with choledochoscopy in the treatment of extrahepatic bile duct stones in basic level hospital.Methods:100 patients with extrahepatic bile duct stones were selected from January 2012 to May 2014.They were divided into the experimental group and the control group according to the different methods of treatment with 50 cases in each.The patients in the experimental group received laparoscopy combined with choledochoscopy to treat the extrahepatic bile duct stones.The patients in the control group underwent conventional open operation treatment.We compared the operation time,the bleeding,postoperative hospital stay,postoperative intestinal function recovery time and the incidence of postoperative pain,postoperative residual stones,biliary fistula,incision infection and other complications of the two groups.Results:Tthe operation time:the experimental group was(150.43 ± 24.28) minutes;the control group was(120.41 ± 11.85) minutes(t=10.37,P<0.05).The amount of bleeding:the experimental group was(28.42 ± 8.14)ml;the control group was(87.16 ± 14.06)ml(t=32.17,P<0.05).The recovery time of bowel the postoperative function:the experimental group was(37.30 ± 3.79) hours;the control group was(72.14 ± 5.38) hours(t=35.22,P<0.05).Postoperative hospitalization:the experimental group was(6.35 ± 1.46) days;the control group was(9.26 ± 2.13) days(t=11.87,P<0.05).Postoperative pain for proportion:the experimental group was 32%;the control group was 54%(χ 2=27.54,P<0.05).Postoperative bile fistula rate:the experimental group was 2%;the control group was 16%(χ 2=21.35,P<0.05).Incision infection rate:the experimental group was 4% ;the control group was 20% ( χ 2=19.47,P<0.05).Two patients had residual stones were no postoperative.Conclusion:Laparoscopy combined with choledochoscopy in the treatment of extrahepatic bile duct stones is safe and effective.It has the advantages of less trauma,quick recovery,postoperative pain,postoperative complications,and hospitalization time short characteristics.So it is suitable for clinical application.