腹腔镜经胆囊管胆总管取石术与胆总管切开取石术比较分析(1)
[摘要] 目的 对比分析腹腔镜经胆囊管胆总管取石术和胆总管切开取石术的临床效果。方法 整群选取2013年9月—2015年9月该院收治的胆总管结石行腹腔镜胆总管探查术患者58例，随机分为两组，各29例。对照组采用胆总管切开取石术，观察组采用经胆囊管胆总管取石术，对比两组手术时间、术后补液量、引流管放置时间、住院时间和并发症情况。结果 观察组术后补液量为(4.31±1.63)L，引流管放置时间为(14.62±2.61)d，均少于对照组，差异有统计学意义(P<0.01)；两组手术时间和住院时间上的差异无统计学意义(P>0.05)；观察组与对照组并发症发生率均为3.45%(1/29)，差异无统计学意义(P>0.05)。结论 腹腔镜经胆囊管胆总管取石术治疗胆总管结石患者明显优于胆总管切开取石术，可明显减少术后补液量，缩短引流管放置时间，并发症少，值得推广。
[关键词] 腹腔镜；经胆囊管胆总管取石术；胆总管切开取石术；疗效
[中图分类号] R657.4 [文献标识码] A [文章编号] 1674-0742(2016)03(b)-0077-03
[Abstract] Objective To compare and analyze the clinical effect of laparoscoplc transcystic common bile duct exploration and choledocholithotomy. Methods 58 cases of patients with choledocholithiasis receiving laparoscopic common bile duct exploration admitted and treated in our hospital from September 2013 to September 2015 were selected and randomly divided into two groups with 29 cases in each， the control group were treated with choledocholithotomy， the observation group were treated with laparoscoplc transcystic common bile duct exploration， the operative time， postoperative fluid supplement amount， drain time， length of stay and complication of the two groups were compared. Results The postoperative fluid supplement amount and drain time were(4.31±1.63) L and (14.62±2.61)d in the observation group， which were lower than those in the control group， and the differences were statistically significant P<0.01， the differences in the operation time and length of stay between the two groups were not obvious P>0.05， the incidence rates of complications in both groups were 3.45% (1/29) and the difference was not statistically significant P>0.05. Conclusion The curative effect of laparoscoplc transcystic common bile duct exploration in treatment of patients with choledocholithiasis is obviously better than that of choledocholithotomy， which can obviously decrease the postoperative fluid supplement amount， shorten drain time with few complications， which is worth promotion.
[Key words] Laparoscoplc； Transcystic common bile duct exploration； Choledocholithotomy； Curative effect
随着腹腔镜技术日益成熟，腹腔镜下胆总管切开取石术被广泛运用，其能有效避免开腹手术对患者机体造成的较大伤害，并且能够保护乳头括约肌，引流胰液和胆汁[1]。但在术后需留置T形管，给患者生活质量造成显著下降。而腹腔镜经胆囊管胆总管取石术可显著避免上述缺点[2-3]。在该研究中对该院自2013年9月—2015年9月收治的胆总管结石行腹腔镜胆总管探查术患者58例，分别给予上述两种方法治疗，对比两组治疗效果，现报道如下。
1 资料与方法
1.1 一般资料
整群选取2013年9月—2015年9月该院收治的胆总管结石行腹腔镜胆总管探查术患者58例，随机分为两组，各29例。对照组男13例，女16例；年龄为25～75岁，平均年龄为(41.61±8.14)岁；平均结石数量为(3.62±1.75)颗；其中伴随腹痛15例、发热8例、黄疸6例。观察组男14例，女15例；年龄为27～78岁，平均年龄为(41.92±8.08)岁；平均结石数量为(3.52±1.73)颗；其中伴随腹痛18例、发热6例、黄疸5例。排除标准：胆管狭窄畸形者；伴随肝内胆管结石者；急性梗阻性化脓性胆管炎者；临床资料不全或不能配合治疗者。两组一般资料差异无统计学意义(P>0.05)。 (张代场 梁辉声 廖伟民 林枫 黄驿胜)
[关键词] 腹腔镜；经胆囊管胆总管取石术；胆总管切开取石术；疗效
[中图分类号] R657.4 [文献标识码] A [文章编号] 1674-0742(2016)03(b)-0077-03
[Abstract] Objective To compare and analyze the clinical effect of laparoscoplc transcystic common bile duct exploration and choledocholithotomy. Methods 58 cases of patients with choledocholithiasis receiving laparoscopic common bile duct exploration admitted and treated in our hospital from September 2013 to September 2015 were selected and randomly divided into two groups with 29 cases in each， the control group were treated with choledocholithotomy， the observation group were treated with laparoscoplc transcystic common bile duct exploration， the operative time， postoperative fluid supplement amount， drain time， length of stay and complication of the two groups were compared. Results The postoperative fluid supplement amount and drain time were(4.31±1.63) L and (14.62±2.61)d in the observation group， which were lower than those in the control group， and the differences were statistically significant P<0.01， the differences in the operation time and length of stay between the two groups were not obvious P>0.05， the incidence rates of complications in both groups were 3.45% (1/29) and the difference was not statistically significant P>0.05. Conclusion The curative effect of laparoscoplc transcystic common bile duct exploration in treatment of patients with choledocholithiasis is obviously better than that of choledocholithotomy， which can obviously decrease the postoperative fluid supplement amount， shorten drain time with few complications， which is worth promotion.
[Key words] Laparoscoplc； Transcystic common bile duct exploration； Choledocholithotomy； Curative effect
随着腹腔镜技术日益成熟，腹腔镜下胆总管切开取石术被广泛运用，其能有效避免开腹手术对患者机体造成的较大伤害，并且能够保护乳头括约肌，引流胰液和胆汁[1]。但在术后需留置T形管，给患者生活质量造成显著下降。而腹腔镜经胆囊管胆总管取石术可显著避免上述缺点[2-3]。在该研究中对该院自2013年9月—2015年9月收治的胆总管结石行腹腔镜胆总管探查术患者58例，分别给予上述两种方法治疗，对比两组治疗效果，现报道如下。
1 资料与方法
1.1 一般资料
整群选取2013年9月—2015年9月该院收治的胆总管结石行腹腔镜胆总管探查术患者58例，随机分为两组，各29例。对照组男13例，女16例；年龄为25～75岁，平均年龄为(41.61±8.14)岁；平均结石数量为(3.62±1.75)颗；其中伴随腹痛15例、发热8例、黄疸6例。观察组男14例，女15例；年龄为27～78岁，平均年龄为(41.92±8.08)岁；平均结石数量为(3.52±1.73)颗；其中伴随腹痛18例、发热6例、黄疸5例。排除标准：胆管狭窄畸形者；伴随肝内胆管结石者；急性梗阻性化脓性胆管炎者；临床资料不全或不能配合治疗者。两组一般资料差异无统计学意义(P>0.05)。 (张代场 梁辉声 廖伟民 林枫 黄驿胜)