摘要
目的观察既往开腹胆囊切除术行腹腔镜再次胆道手术治疗胆总管结石的临床效果。方法选取58例既往开腹胆囊切除术的再次手术患者,采用随机数字表法将其分为对照组与观察组,观察组29例行腹腔镜胆总管探查取石术,对照组29例行开腹胆总管探查取石术。观察2组围手术指标(术中出血量、手术时间、疼痛持续时间、排气时间及住院时间)、术后并发症(胆瘘、切口感染、胆道狭窄、结石残余)、肝功能水平。结果观察组疼痛持续时间、住院时间、排气时间及术中出血量均少于对照组,差异有统计学意义(P<0.05);2组手术时间差异无统计学意义(P>0.05)。2组结石残余、胆瘘、切口感染、胆道狭窄各项并发症发生率差异并无统计学意义(P>0.05);但观察组总并发症发生率低于对照组,差异有统计学意义(P<0.05)。术前2组天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素水平差异无统计学意义(P>0.05);术后2周2组上述指标均有明显下降(P<0.05),但2组间差异无统计学意义(P>0.05)。结论对于开腹胆囊切除术患者,腹腔镜再次胆道手术治疗胆总管结石创伤小,术后恢复快,且并发症发生率低,有助于患者肝功能恢复。
Objective To investigate the clinical efficacy of laparoscopic cholecystectomy for choledocholithiasis after open cholecystectomy.Methods A total of 58 cases of open cholecystectomy patients were divided into control group and observation group using random number table method.The observation group of 29 cases were underwent laparoscopic choledocholithotomy, other 29 cases were underwent open choledocholithotomy.The perioperative indicators（blood loss, operative time, pain duration, exhaust time and hospitalization time）, postoperative complications（biliary fistula, incision infection, biliary stricture, residual stones） and liver functionswere were observed in two groups.Results The observation group pain duration, hospitalization time, exhaust time and amount of bleeding in operation were less than that in the control group, the difference was statistically significant（ P 〈 0.05）. The two groups had no statistically significant differences in operative time, the incidence of residual stones, biliary fistula, incision infection and biliary stricture of various complications（ P 〉 0.05）. The total complication rate in the observation group was significantly lower than that in the control group（ P 〈 0.05）. Before operation, there was no significant difference between 2 groups of aspartate aminotransaferase, alanine aminotransferase and total bilirubin（ P 〉 0.05）. Two weeks after the operation, the above indexes between 2 groups were significantly decreased（ P 〈 0.05）, but there was no statistical difference between 2 groups（ P 〉 0.05）.Conclusion For patients undergoing open cholecystectomy, laparoscopic choledocholithotomy has less trauma, rapid postoperative recovery, and low complications, which is helpful to the recovery of liver function.
作者
唐彤
张军
陈磊
刘明忠
TANG Tong;ZHANG Jun;CHEN Lei;LIU Ming-zhong(Department of Liver and Gallbladder Surgery,Dazhou Center Hospital,Sichuan Province,Dazhou 635000,China)
出处
《河北医科大学学报》
CAS
2018年第11期1300-1303,1310,共5页
Journal of Hebei Medical University
关键词
胆总管结石
腹腔镜
开腹胆囊切除术
choledocholithiasis
laparoscopes
open cholecystectomy
