CAJ | 학술논문

目的：探讨比较腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石疗效。方法回顾性分析2011年1月至2013年12月该科收治的95例行手术治疗的胆囊结石合并胆总管结石患者临床资料，根据手术方式分为对照组（n＝45）和观察组（n＝50）。对照组行传统开腹手术，观察组行腹腔镜联合胆道镜手术。比较两组患者手术时间、术中出血量、术后肛门排气时间、住院时间等手术情况、术后并发症发生率及结石复发率。结果与对照组相比，观察组术中出血量明显减少，术后肛门排气时间及住院时间明显缩短，比较差异有统计学意义（P＜0．05），而手术时间组间比较差异无统计学意义（P＞0．05）。术后，观察组并发症发生率为6．0％，明显低于对照组20．0％的并发症发生率（P＜0．05）。随访1年，观察组和对照组的结石复发率分别为2．0％和4．4％，组间比较差异无统计学意义（P＞0．05）。结论腹腔镜联合胆道镜是治疗胆囊结石合并胆总管结石的有效手术方式，与传统开腹手术相比，术中出血量少、术后恢复快、术后并发症发生率低，值得临床进一步推广。
목적：탐토비교복강경연합담도경여전통개복수술치료담낭결석합병담총관결석료효。방법회고성분석2011년1월지2013년12월해과수치적95례행수술치료적담낭결석합병담총관결석환자림상자료，근거수술방식분위대조조（n＝45）화관찰조（n＝50）。대조조행전통개복수술，관찰조행복강경연합담도경수술。비교량조환자수술시간、술중출혈량、술후항문배기시간、주원시간등수술정황、술후병발증발생솔급결석복발솔。결과여대조조상비，관찰조술중출혈량명현감소，술후항문배기시간급주원시간명현축단，비교차이유통계학의의（P＜0．05），이수술시간조간비교차이무통계학의의（P＞0．05）。술후，관찰조병발증발생솔위6．0％，명현저우대조조20．0％적병발증발생솔（P＜0．05）。수방1년，관찰조화대조조적결석복발솔분별위2．0％화4．4％，조간비교차이무통계학의의（P＞0．05）。결론복강경연합담도경시치료담낭결석합병담총관결석적유효수술방식，여전통개복수술상비，술중출혈량소、술후회복쾌、술후병발증발생솔저，치득림상진일보추엄。
Objective To compare the curative efficacy of laparoscope combined with choledochoscope and tra‐ditional open surgery in the treatment of cholecystolithiasis complicated with choledocholithiasis .Methods The clini‐cal data in 95 cases of cholecystolithiasis complicated with choledocholithiasis treated with surgery in our hospital from January 2011 to December 2013 were retrospectively analyzed .The patients were divided into the control group (n= 45) and the observation group(n= 50) according to the operation modes .The control group was given the tradi‐tional open surgery ,while the observation group was performed the laparoscopy combined with choledochoscopy op‐eration .Then the operation time ,introperative bleeding volume ,postoperative anal exhausting time ,hospitalization time ,incidence of postoperative complications and calculi recurrence rate were compared between the two groups .Re‐sults Compared with the control group ,the intraoperative bleeding volume in the observation group was significantly decreased ,postoperative anal exhausting time and the hospitalization time were significantly shortened ,the differences were statistically significant (P< 0 .05) ,while the peration time had no statistical difference between the two groups (P> 0 .05) .The incidence rate of postoperative complications in the observation group was 6 .0% ,which was signifi‐cantly lower than 20 .0% in the control group(P< 0 .05) .After the one‐year follow‐up ,the calculi recurrence rate was 2 .0% in the observation group and 4 .4% in the control group ,showing no statistical difference between them(P>0 .05) .Conclusion Laparoscopy combined with choledochoscopy is an effective and safe operation mode for treating cholecystolithiasis complicated with choledocholithiasis ,in comparison with the traditional open surgery ,which has less bleed loss during surgery ,rapid postoperative recovery and lower incidence of postoperative complications ,and is worthy clinical further promotion .