【摘要】 目的探讨腹腔镜3种手术方式治疗胆囊结石及胆总管结石的应用价值。方法将88例胆囊结石合并胆总管结石患者随机分为3组,组1(21例)行腹腔镜胆囊切除+经胆道镜胆总管探查+T管引流术;组2(30例)行经腹腔镜胆囊切除+经胆道镜胆总管探查+一期缝合;组3(37例)行经腹腔镜胆囊切除+经胆道镜胆总管探查,术中胃镜辅助放置鼻胆管引流+一期缝合胆总管。比较3组患者手术时间、术后胃肠道功能恢复时间、肝功能恢复时间、手术后并发症和住院时间等指标。结果 3组均未出现严重并发症,3组患者术后胆红素和转氨酶恢复、血尿淀粉酶升高及胆汁丢失量等方面比较差异有统计学意义(P<0.01),组2肝功能恢复时间最慢(P<0.01),组3在术后肝功能恢复时间和术后并发症发生率明显优于组1和组2(P<0.01)。结论腹腔镜胆囊切除+胆总管探查术具有创伤小、恢复快、结石残余率低的特点,术中胃镜辅助放置鼻胆管引流相对简单、安全,可以扩大胆总管一期缝合的应用范围,加快肝功能恢复,减少并发症的发生,有推广价值。更多还原

【Abstract】 Objective To investigate the value of clinical use of laparoscopy,choledochoscopy and endoscopic nasobiliary drainage in treatment of cholecystolithiasis combined with choledocholithiasis.Meth-ods 88 patients suffering from eholecystolithiasis combined with eholedocholithiasis are randomly divided into three groups: 21 patients in Group 1 underwent laparoscopic cholecystectomy together with choledocholithotomy(LCDE) and T-tube drainage;30 patients in Group 2 underwent laparoscopic cholecystectomy together with choledocholithotomy and primary suture;37 patients in Group 3 underwent laparoscopic olecystectomy together with choledocholithotomy,gastroscopy-assisted ENBD intraoperative and primary suture.Patients in three groups were compared to each other in operative time,postoperative gastrointestinal function recovery time,liver function recovery time,postoperative complications and hospitalization time.Results There are no serious complications in three groups.The comparative differences in patients of three groups on bilirubin and transaminase recovery,elevated urine amylase and the amount of bile loss were statistically significant(P<0.01).The liver function recovery time of Group 2 is the slowest(P<0.01),Group 3 was significantly better than the other two groups in the incidence of postoperative recovery of liver function and postoperative complications(P<0.01).Conclusion LCTD has the characteristics of less trauma,faster recovery and low rate of stone residual.Being comparatively simple and safe,Gastroscopy-assisted ENBD intraoperative,which can expand the scope of application of the common bile duct primary suture,speed up the recovery of liver function and reduce the incidence of complications,has promotional value.更多还原