探讨腹腔镜手术治疗复发性胆总管结石的安全性和疗效。

回顾性分析2013年1月至2018年4月周口市中心医院收治的246例复发性胆总管结石患者临床资料。其中男120例，女126例；年龄40～85岁，中位年龄62岁。患者均签署知情同意书，符合医学伦理学要求。根据手术方式不同将患者分为腹腔镜组（134例）和开腹组（112例）。两组患者手术时间、术中出血量等围手术期情况比较采用t检验，并发症发生率等比较采用χ²检验。

两组手术均获得成功，无发生围手术期死亡。腹腔镜组患者手术时间、术中出血量、术后首次肛门排气时间、术后住院时间分别为（90±16） min、（26±14） ml、（25.7±1.4） h、（7.2±0.7） d，明显少于开腹组的（130±17）min、（41±18）ml、（72.5±5.3） h、（13.2±1.5） d （t=-26.871，-33.214，-17.971，-6.552；P<0.05）。腹腔镜组术后镇痛剂使用率和术后切口感染发生率分别为5.2%（7/134）、2.2%（3/134），明显低于开腹组的71.4%（80/112）、9.8%（11/112） （χ²=45.950，25.510；P<0.05）。

与开腹手术相比，腹腔镜手术治疗复发性胆总管结石具有安全、创伤小、术后恢复快等优势，为其治疗提供新的选择。

To evaluate the safety and efficacy of laparoscopic surgery for recurrent common bile duct stones.

Clinical data of 246 patients with recurrent common bile duct stones admitted to Zhoukou Central Hospital from January 2013 to April 2018 were retrospectively analyzed. Among them, 120 patients were male and 126 female, aged 40-85 years with a median age of 62 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were divided into the laparoscopic surgery group (n=134) and open surgery group (n=112) according to different surgical methods. The perioperative conditions, such as the operation time and intraoperative blood loss were statistically compared between two groups by t test. The incidence of postoperative complications was compared by Chi-square test.

All surgeries were successfully completed in two groups. No perioperative death occurred. In the laparoscopic surgery group, the operation time, intraoperative blood loss, postoperative anal exhaust time and length of postoperative hospital stay were respectively (90±16) min, (26±14) ml, (25.7±1.4) hand (7.2±0.7) d, significantly less than (130±17) min, (41±18) ml, (72.5±5.3) h and (13.2±1.5) d in the open surgery group (t=-26.871, -33.214, -17.971, -6.552; P<0.05). In the laparoscopic surgery group, the usage rate of analgesics and the incidence of postoperative incisional infection were respectively 5.2% (7/134) and 2.2% (3/134), significantly lower than 71.4% (80/112) and 9.8% (11/112) in the open surgery group (χ²= 45.950, 25.510; P<0.05).

Compared with open surgery, laparoscopic surgery possesses the advantages of safe, smaller trauma and faster postoperative recovery for patients with recurrent common bile duct stones, providing a novel treatment option.