腹腔镜下联合应用新型硬质胆道镜行保胆息肉摘除术(1)
[摘要] 目的 探讨腹腔镜下联合应用新型硬质胆道镜(CHIAO牌)行保胆息肉摘除术的临床有效性及安全性。 方法 选取2013年1月～2015年5月在我院普外科住院治疗的胆囊息肉样病变患者共95例，其中45例行腹腔镜胆囊切除术(LC组)，50例行腹腔镜下联合新型硬质胆道镜微创保胆息肉摘除术(双镜组)，比较两组患者的手术时间、术中出血量、术后排气时间、术后住院时间、总住院费用；出院后6个月～1年对患者术后并发症、胆总管宽度、症状分级及生存质量等进行随访分析。 结果 两组患者手术均获得成功，无中转开腹病例。双镜组患者在术中出血、术后排气时间及术后并发症发生率方面均少于LC组(P<0.05)；手术时间、术后住院时间及总住院费用双镜组与LC组比较差异无显著性(P>0.05)；患者出院后6个月～1年至少复查一次B超，双镜组患者术后胆总管宽度明显小于LC组患者，差异有统计学意义(P<0.05)；双镜组患者远期症状分级Ⅰ级比例明显高于LC组患者，而其Ⅱ级、Ⅲ级比例明显低于LC组患者，组间差异均具有显著性(P<0.05)。 结论 腹腔镜下联合应用新型硬质胆道镜行保胆息肉摘除术治疗有效、安全，具有创伤小、出血少、术后恢复快、远期症状缓解程度高及生存质量高等优点，值得在临床实践中推广应用。
[关键词] 胆囊息肉样变；腹腔镜；硬质胆道镜；保胆；微创；术后并发症
[中图分类号] R657.42 [文献标识码] B [文章编号] 1673-9701(2016)14-0044-05
[Abstract] Objective To explore the efficacy and safety of laparoscopic combined with new type of rigid choledochoscopic(CHIAO) cholecystolithotomy in gallbladder polyps extirpation. Methods A total of 95 patients with polypoid lesions of gallbladder in the department of general surgery were enrolled in a retrospective study from January 2013 to May 2015. Among them， 45 cases underwent conventional laparoscopic cholecystectomy(LC group)， the other 50 cases underwent laparoscopic combined with new type of rigid choledochoscopic cholecystolithotomy(Double lens group). Comparative analysis was made between the two groups on time of operation， intraoperative amount of bleeding and postoperative time of anal exhaust， postoperative hospitalization time， overall hospitalization expense， post-discharge complications， common bile duct width， symptomatic grading， quality of life value. Results All operations for both groups went on successfully with no cases requiring laparotomy. The intraoperative amount of bleeding， postoperative time of anal exhaust and post-discharge complications of Double lens group was shorter than that of LC group， the difference was statistically significant(P<0.05). No significant differences were displayed between the two groups on time of operation， postoperative hospitalization time， overall hospitalization expense(P>0.05). The follow-up B ultrasonic examinations at 6 months to 1 year after operation revealed. The common bile duct width of Double lens group was shorter than that of LC group， the difference was statistically significant(P<0.05). The patients in Double lens group the late symptom grade Ⅰ ratio was significantly higher than that in LC group， and the grade Ⅱ， Ⅲ was significantly lower than the LC group patients， the difference between the above groups were statistically significant(P<0.05). Conclusion The laparoscopic combined with new type of rigid choledochoscopic cholecystolithotomy in gallbladder polyps extirpation is effective and safe， with less trauma， faster postoperative， patients with less bleeding， high degree of long-term remission symptoms， quality of life is high， it is worthy of popularization and application in clinical practice., 百拇医药(蔡建华 蒋飞照 李剑锋)
[关键词] 胆囊息肉样变；腹腔镜；硬质胆道镜；保胆；微创；术后并发症
[中图分类号] R657.42 [文献标识码] B [文章编号] 1673-9701(2016)14-0044-05
[Abstract] Objective To explore the efficacy and safety of laparoscopic combined with new type of rigid choledochoscopic(CHIAO) cholecystolithotomy in gallbladder polyps extirpation. Methods A total of 95 patients with polypoid lesions of gallbladder in the department of general surgery were enrolled in a retrospective study from January 2013 to May 2015. Among them， 45 cases underwent conventional laparoscopic cholecystectomy(LC group)， the other 50 cases underwent laparoscopic combined with new type of rigid choledochoscopic cholecystolithotomy(Double lens group). Comparative analysis was made between the two groups on time of operation， intraoperative amount of bleeding and postoperative time of anal exhaust， postoperative hospitalization time， overall hospitalization expense， post-discharge complications， common bile duct width， symptomatic grading， quality of life value. Results All operations for both groups went on successfully with no cases requiring laparotomy. The intraoperative amount of bleeding， postoperative time of anal exhaust and post-discharge complications of Double lens group was shorter than that of LC group， the difference was statistically significant(P<0.05). No significant differences were displayed between the two groups on time of operation， postoperative hospitalization time， overall hospitalization expense(P>0.05). The follow-up B ultrasonic examinations at 6 months to 1 year after operation revealed. The common bile duct width of Double lens group was shorter than that of LC group， the difference was statistically significant(P<0.05). The patients in Double lens group the late symptom grade Ⅰ ratio was significantly higher than that in LC group， and the grade Ⅱ， Ⅲ was significantly lower than the LC group patients， the difference between the above groups were statistically significant(P<0.05). Conclusion The laparoscopic combined with new type of rigid choledochoscopic cholecystolithotomy in gallbladder polyps extirpation is effective and safe， with less trauma， faster postoperative， patients with less bleeding， high degree of long-term remission symptoms， quality of life is high， it is worthy of popularization and application in clinical practice., 百拇医药(蔡建华 蒋飞照 李剑锋)