微创医学

目的探讨腹腔镜带蒂胆囊瓣胆道修复术对肝内胆管结石并肝门部胆管狭窄的治疗效果。方法选取80例肝内胆管结石合并肝门部胆管狭窄的患者为研究对象，随机分为对照组40例和观察组40例。对照组采取术中胆道取石、胆管狭窄整形及胆肠RouxenY吻合术，观察组则采用腹腔镜取石及带蒂胆囊瓣胆道修复术。观察记录两组患者手术操作时间、术中出血量、出院时间及结石取出情况；随访1年，比较两组结石复发率、胆道狭窄再发率及术后远期并发症发生率。结果与对照组相比较，观察组的手术操作时间和住院时间明显缩短，术中出血量明显减少（P＜0.05）；观察组结石取净率明显高于对照组（P＜0.05）；观察组结石复发率、胆道狭窄再发率及术后并发症发生率都明显低于对照组（P＜0.05）。结论腹腔镜带蒂胆囊瓣胆道修复术治疗肝内胆管结石合并肝门部胆管狭窄效果显著，且术后并发症发生率低。

Objective To investigate the efficacy of laparoscopic cholangio plasty with pedicled gallbladder flap in treatment of hepatolithiasis with hilar bile duct stricture. Methods 80 cases with hepatolithiasis complicating hilar bile duct stricture were randomly divided into the control group and observation group. Patients in control group were given intraoperative taking biliary stone, biliary stricture plastic surgery, and bilioenteric RouxenY anastomosis, patients in observation group were given taking stone under laparoscopic and cholangio plasty with pedicled gallbladder flap. The operation time, blood loss, discharge time, and stone removal status of two groups were observed and recorded. All patients were followed up for 1 year, the stone recurrence rate, biliary stricture recurrence rate, and postoperative complications rate of two groups were observed. Results Compared with control group, the operation time, blood loss, and hospital stay time of observation group were significantly lower (P＜0.05); The stone net rate of observation group was significantly higher than that of control group(P＜0.05); The stone recurrence rate, biliary stricture recurrence rate, and postoperative complications rate of observation group were significantly lower than those of control group (P＜0.05). Conclusions Laparoscopic cholangio plasty with pedicled gallbladder flap can effectively treat hepatolithiasis complicating hilar bile duct stricture, with low complication rate.