陳志雄 謝云鶴 周圣助

摘 要 目的：觀察輸尿管鏡代替膽道鏡行腹腔鏡膽總管切開(kāi)取石術(shù)的臨床效果。方法：將膽總管結(jié)石患者60例按隨機(jī)數(shù)字表法分為觀察組（n=30）和對(duì)照組（n=30）。觀察組給予輸尿管鏡+腹腔鏡膽總管切開(kāi)取石術(shù)治療，對(duì)照組給予膽道鏡+腹腔鏡膽總管切開(kāi)取石術(shù)治療。比較兩組手術(shù)總有效率、手術(shù)情況及術(shù)后恢復(fù)情況。結(jié)果：觀察組手術(shù)總有效率高于對(duì)照組；手術(shù)時(shí)間、術(shù)后住院時(shí)間及術(shù)后肛門排氣時(shí)間、引流管拔除時(shí)間及首次下床時(shí)間均短于對(duì)照組，術(shù)中出血量少于對(duì)照組；術(shù)后7 d血清TBIL、AST、ALT水平及VAS評(píng)分均低于對(duì)照組，術(shù)后并發(fā)癥發(fā)生率低于對(duì)照組（均P<0.05）。結(jié)論：將輸尿管鏡應(yīng)用于腹腔鏡膽總管切開(kāi)取石術(shù)中，可提高結(jié)石取盡率，縮短手術(shù)時(shí)間及術(shù)后住院時(shí)間，并且可促進(jìn)術(shù)后肝功能恢復(fù)。

關(guān)鍵詞 輸尿管鏡 膽道鏡 腹腔鏡膽總管切開(kāi)取石術(shù) 臨床效果

中圖分類號(hào)：R657.4 文獻(xiàn)標(biāo)志碼：B 文章編號(hào)：1006-1533（2021）19-0027-05

基金項(xiàng)目：江西省衛(wèi)生健康委科技計(jì)劃（20204301）

Effect of laparoscopic choledocholithotomy with ureteroscope instead of choledochoscope

CHEN Zhixiong， XIE Yunhe， ZHOU Shengzhu

（Department of General Surgery， the Peoples Hospital of Duchang County， Jiujiang 332600， China）

ABSTRACT Objective： To observe the clinical effect of laparoscopic choledocholithotomy with ureteroscope instead of choledochoscope. Methods： Sixty patients with choledocholithiasis were randomly divided into an observation group （n=30） and a control group （n=30）. The observation group underwent ureteroscope plus laparoscopic choledocholithotomy， while the control group underwent choledochoscope plus laparoscopic choledocholithotomy. Operation overall response rate， operation condition and postoperative recovery were compared between the two groups. Results： The overall response rate was higher， the times for operation， hospital stay， postoperative anal exhaust， drainage tube extraction and the first time out of bed were shorter and the levels of serum TBIL， AST， ALT， the scores of VAS on the 7th day after operation and the incidence of postoperative complications were lower in the observation group than the control group （all P<0.05）. Conclusion： The application of ureteroscope in laparoscopic choledocholithotomy can increase stone-free rate， shorten the times for operation and postoperative hospitalization and promote the recovery of postoperative liver function.

KEy wORDS ureteroscope； choledochoscope； laparoscopic choledocholithotomy； clinical effect

膽總管結(jié)石是肝膽外科的常見(jiàn)病及多發(fā)病，常繼發(fā)于膽囊結(jié)石，易并發(fā)急性膽源性胰腺炎、急性化膿性膽管炎以及肝功能損害等，并且發(fā)病期患者常表現(xiàn)為劇烈疼痛，嚴(yán)重影響其生活質(zhì)量[1]。手術(shù)治療仍為治療膽總管結(jié)石最重要及最徹底的手段，隨著微創(chuàng)技術(shù)的進(jìn)步，腹腔鏡手術(shù)在膽總管結(jié)石的治療中已得到廣泛的應(yīng)用。目前臨床上常采用膽道鏡及腹腔鏡手術(shù)治療膽總管結(jié)石，但患者術(shù)后需長(zhǎng)時(shí)間留置T管，給患者的日常生活帶來(lái)了諸多不便，且拔除T管后發(fā)生膽漏、膽汁性腹膜炎等并發(fā)癥[2]。有報(bào)道指出，采用腹腔鏡聯(lián)合輸尿管鏡行膽結(jié)石切開(kāi)取石術(shù)，可縮短T管留置時(shí)間，降低術(shù)后并發(fā)癥發(fā)生率[3]。輸尿管鏡手術(shù)是指窺鏡經(jīng)尿道、膀胱進(jìn)入輸尿管，醫(yī)師可在窺鏡的引導(dǎo)下直觀地觀察膽道情況，比膽道鏡下的視野更清晰。為進(jìn)一步探究輸尿管鏡代替膽道鏡行腹腔鏡膽總管切開(kāi)取石術(shù)的臨床效果，本研究對(duì)膽總管結(jié)石患者應(yīng)用輸尿管鏡行腹腔鏡膽總管切開(kāi)取石術(shù)治療，取得較好的療效，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 臨床資料

將2018年6月至2019年12月在我院行手術(shù)治療的膽總管結(jié)石患者60例按隨機(jī)數(shù)字表法分為觀察組（n=30）和對(duì)照組（n=30）。兩組患者一般資料對(duì)比無(wú)明顯差異（P>0.05，表1）。