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目的：观察腹腔镜联合硬质胆道镜治疗复发性肝胆管结石的临床应用。方法：选取2013 年1 月-2014 年1 月期间在广州医科大学附属第一医院治疗的复发性肝胆管结石患者64 例，随机分为研究组和对照组，研究组患者给予腹腔镜联合硬质胆道镜治疗，对照组患者采取开腹治疗。观察并比较两组患者的临床效果。结果：研究组患者手术出血量、手术时间、肛门排气时间、术后胆红素恢复时间、平均住院时间和抗生素应用时间均少于或短于对照组，差异均有统计学意义（均P＜0.05）；研究组患者术后发生感染、胆漏、出血、结石残余与对照组比较差异均无统计学意义（均P＞0.05）；研究组患者术后疼痛3 例显著高于对照组的15 例（P＜0.05）。结论：腹腔镜联合硬质胆道镜治疗复发性肝胆管结石对患者损伤小、手术过程中出血量少、结石取出率高、残留可能性小、结石复发率低、术后恢复快、并发症发生率低，其可行性和安全性高，适应范围广，值得推广应用。

英文摘要:

Objective:To observe the clinical application of laparoscopy combined with rigid choledochoscopy in treatment of recurrent hepatolithiasis.Methods:64 cases of patients with recurrent hepatolithiasis during January 2013 to January 2014 in our hospital were randomly divided into the study group and the control group. Patients in the study group received laparoscopy combined with rigid choledochoscope for treatment, while those in the the control group received laparotomy. The clinical effect of the two groups were observed and compared.Results:The bleeding volume, operation time, anal exhaust time, bilirubin recovery time, hospitalization time and antibiotic application time of the study group was less or shorter than that of the control group, and the difference was statistically significant (all P<0.05); There was no significant difference in the postoperative infection, bile leakage, bleeding, and residual stones between the two groups (all P>0.05); 3 cases of patients with postoperative pain in the study group was significantly higher than 15 cases in the control group (P<0.05).Conclusion:Laparoscopy combined with rigid choledochoscopy in treatment of recurrent hepatolithiasis has an advantage of less damage for patients, less bleeding during surgery, stone removal rate, the possibility of residual small stone recurrence rate, rapid postoperative recovery, low complication rate, feasibility and safety, as well as wide adaptability, and it is worthy of popularization and application.

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