输尿管镜代替胆道镜行腹腔镜胆总管切开取石术的效果分析

2021-11-04陈志雄谢云鹤周圣助

上海医药 2021年19期

陈志雄谢云鹤周圣助

摘要目的：观察输尿管镜代替胆道镜行腹腔镜胆总管切开取石术的临床效果。方法：将胆总管结石患者60例按随机数字表法分为观察组（n=30）和对照组（n=30）。觀察组给予输尿管镜+腹腔镜胆总管切开取石术治疗，对照组给予胆道镜+腹腔镜胆总管切开取石术治疗。比较两组手术总有效率、手术情况及术后恢复情况。结果：观察组手术总有效率高于对照组；手术时间、术后住院时间及术后肛门排气时间、引流管拔除时间及首次下床时间均短于对照组，术中出血量少于对照组；术后7 d血清TBIL、AST、ALT水平及VAS评分均低于对照组，术后并发症发生率低于对照组（均P<0.05）。结论：将输尿管镜应用于腹腔镜胆总管切开取石术中，可提高结石取尽率，缩短手术时间及术后住院时间，并且可促进术后肝功能恢复。

关键词输尿管镜胆道镜腹腔镜胆总管切开取石术临床效果

中图分类号：R657.4 文献标志码：B 文章编号：1006-1533（2021）19-0027-05

基金项目：江西省卫生健康委科技计划（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

胆总管结石是肝胆外科的常见病及多发病，常继发于胆囊结石，易并发急性胆源性胰腺炎、急性化脓性胆管炎以及肝功能损害等，并且发病期患者常表现为剧烈疼痛，严重影响其生活质量[1]。手术治疗仍为治疗胆总管结石最重要及最彻底的手段，随着微创技术的进步，腹腔镜手术在胆总管结石的治疗中已得到广泛的应用。目前临床上常采用胆道镜及腹腔镜手术治疗胆总管结石，但患者术后需长时间留置T管，给患者的日常生活带来了诸多不便，且拔除T管后发生胆漏、胆汁性腹膜炎等并发症[2]。有报道指出，采用腹腔镜联合输尿管镜行胆结石切开取石术，可缩短T管留置时间，降低术后并发症发生率[3]。输尿管镜手术是指窥镜经尿道、膀胱进入输尿管，医师可在窥镜的引导下直观地观察胆道情况，比胆道镜下的视野更清晰。为进一步探究输尿管镜代替胆道镜行腹腔镜胆总管切开取石术的临床效果，本研究对胆总管结石患者应用输尿管镜行腹腔镜胆总管切开取石术治疗，取得较好的疗效，现报道如下。