腹腔镜胆道探查临床应用分析(附340例报告)

Clinical application of laparoscopic bile duct exploration:an analysis of 340 cases

目的 评价腹腔镜胆道探查的优越性。方法 前瞻性设计 ,将诊断为胆总管结石或合并胆囊结石的病人分成四组 :腹腔镜下胆总管切开取石 (一期缝合 )组 ;腹腔镜下胆总管切开取石 (置T管 )组 ;传统开腹胆总管一期缝合组 ;传统开腹置T管组。对于手术效果进行统计分析。结果 四组胆漏发生率分别为 5 0 %、3 3%、5 0 %、3 8% ,术后肠道恢复平均时间分别为 2 1d、2 6d、3 3d、3 5d。结论 腹腔镜胆总管结石胆道探查术具有并发症率低、住院时间短、痛苦少、恢复快等优点 ,是一种安全、有效的好方法。

Objective To evaluate the advantages of laparoscopic bile duct exploration. Methods The subjects were 340 patients with choledocholithiasis or combined cholecystolithiasis treated in our hospital from March 2001 to March 2003. The 340 patients were divided into the following 4 groups: 1) the group of laparoscopic choledocholithotomy with primary suture;2) the group of laparoscopic choledocholithotomy with T-tube drainage;3) the group of open choledocholithotomy with primary suture;4) the group of open choledocholithotomy with T-tube drainage. Statistical analysis was used to evaluate the advantages or disadvantages of various operating methods. Results The occurring rate of bile leakage was 5%, 3.3%, 5% and 3.75% and the average time of postoperative gastroenteric recovery was 2.1, 2.55, 3.3 and 3.52 days, respectively, in the 4 groups. Conclusions Laparoscopic bile duct exploration is characterized by lower occurring rate of complications, shorter time of hospitalization, less pain and rapid recovery. Therefore, it is a good method.