摘要
目的比较腹腔镜胆囊切除+经胆囊管胆总管探查取石术(laparoscopic transcyctic common bile duct exploration,LTCBDE)与腹腔镜胆囊切除+胆总管切开取石+鼻胆管置入+胆总管一期缝合术(以下简称为三镜联合术)治疗胆囊结石合并胆总管结石的临床疗效。方法胆囊结石合并胆总管结石患者410例,其中A组130例,行LTCBDE术;B组280例,行三镜联合术;比较A组和B组的手术时间、术中出血量、术后住院时间、住院费用、结石残留率、术后并发症发生率以及安全性和可行性。结果 A、B两组的手术时间分别为(105.32±29.60)分钟和(124.47±44.88)分钟,术中出血量分别为(27.26±14.33)ml和(68.12±16.47)ml,术后住院时间分别为(5.38±1.08)天和(7.35±1.36)天,住院费用分别为(25182.16±3190.35)元和(47389.87±2608.01)元,两组比较差异有统计学意义(P<0.05),A组优于B组。两组患者中均无死亡及需二次手术病例。A组术后出现并发症2例(1.5%),B组11例(3.9%),两组比较差异无统计学意义(P>0.05)。结论与三镜联合术比较,腹腔镜经胆囊管胆总管探查取石术手术时间短、术中出血少、恢复快、费用低,适合较小的胆总管结石。临床医生可根据患者病情选择合适的手术方式。
Objective To compare the safety and applicability of laparoscopic transcystic common bile duct exploration（LTCBDE）and combined duodenoscopic,laparoscopic and choledochoscopic common bile duct exploration（namely Tri-scopy common bile duct exploration）in treatment of cholecystolithiasis.Methods We retrospectively enrolled 410 consecutive patients with choledocholithiasis.Among these people,130 patients received LTCBDE（group A）,and 280 patients underwent Tri-scopy common bile duct exploration（group B）.The variables of two groups（including the demographic factors,operative time,intraoperative blood loss,length of hospital stay,cost of hospitalization stay,stone clearance,and postoperative complications）were collected and analyzed.Results There were no significant differences between two groups in age,gender,jaundice,serum ALT,the diameter of the common bile duct and the number of stones（with all P〉0.05）.The mean diameter of the stones in group A was smaller than that in group B（P〈0.05）.There was no severe complication resulting in death and reoperation.There was no significant difference in the incidence of complications between Group A and Group B（P〉0.05）.Group A had shorter operation time[（105.32±29.60）min vs（124.47±44.88）min）],less blood loss[（27.26±14.33）ml vs.（68.12±16.47）ml],less hospital stay [（5.38±1.08）d vs（7.35±1.36）d] and lower cost[￥（25182.16±3190.35）vs ￥（47389.87±2608.01）],with all P〈0.05 compared to group B.Conclusion LTCBDE which is suitable for smaller CBD stones,has shorter operation time,less blood loss,less hospital stay and lower cost.Surgeons should choose the best surgical method depending on the patients＇ situation.
出处
《临床外科杂志》
2017年第6期431-433,共3页
Journal of Clinical Surgery
基金
武汉市科技攻关资助项目(201260523171-3)
华中科技大学自主创新研究基金资助项目(2013YLQX006)
关键词
腹腔镜
胆道镜
胆总管探查术
经胆囊管
胆总管结石
larparoscopy
choledochoscopy
common bile duct exploration
transcystic
choledocholithiasis
