腹腔镜与开腹保胆取石术治疗胆囊结石的对比研究

Comparison of Laparoscopy and Open Surgery for Gallbladder Preservation in Patients with Cholelithiasis

目的比较腹腔镜下与开腹肋缘下小切口保胆取石术治疗胆囊结石的疗效。方法2006年4月～2008年5月保胆取石术治疗胆囊结石63例,其中腹腔镜下完成33例(腹腔镜组),开腹肋缘下小切口完成30例(小切口组),比较2组手术时间、术后排气时间、术后止痛药使用率、术后并发症发生率、术后住院时间、住院费用。结果腹腔镜组手术时间(66.4±10.6)min显著长于开腹组(60.6±9.8)min(t=2.248,P=0.020);腹腔镜组住院费用(7865±992)元明显高于开腹组(6995±825)元(t=3.765,P=0.000);腹腔镜组术后排气时间(22.7±6.9)h显著短于开腹组(36.9±17.2)h(t=-4.374,P=0.000);腹腔镜组术后住院时间(4.8±1.5)d显著短于开腹组(10.0±7.4)d(t=-3.951,P=0.000);腹腔镜组术后并发症发生率(1例脐周感染)显著少于开腹组(2例切口血肿,2例切口感染,3例盆腔积液,1例粘连性肠梗阻)(χ2=5.369,P=0.020)。结论腹腔镜下保胆取石术具有创伤小、恢复快、并发症少、住院时间短等优点,是微创保留胆囊治疗胆囊结石理想的手术方式。

Objective To compare the surgical effects of laparoscopy and open mini-incision surgery in cholelithotomy with the gallbladder being preserved. Methods From April 2006 to May 2008, 63 cases of cholelithiasis received cbolelithotomy with the gallbladder being preserved in our hospital by laparoscopy （ n = 33 ） or mini-incision open surgery （ n = 30）. The operation time, recovery time of gastrointestinal function, rates of postoperative analgesics use and complications, inpatient charge, and drug expense after the operation were analyzed. Results The mean operation time in laparoscopy group was significantly longer than that in open group [（66.4± 10.6） rain vs （60.6±9.8） rain, t =2.248, P =0.020）]. And the inpatient charge in laparoscopy group was significantly higher than that in the open group [ （7865±992） yuan vs （6995 ±825） yuan, t=3. 765, P =0. 000） ]. Whereas, the recovery time of the gastrointestinal tract and postoperative hospital stay in the laparoscopy group was significantly shorter than those in the other [（22.7±6.9） h vs （36.9 ±17.2） h, t = -4.374, P=0.000）; （4.8 ±1.5）d vs （10.0±7.4） d, t= -3.951, P= 0. 000）]. In the laparoscopy group, only one patient showed complication （periumbilical infection） after the treatment, while in the open group, 2 patients developed incisional hematoma, 2 showed incisional infection, 3 had pelvic effusion, and 1 suffered from adhesive intestinal obstruction （X^2 = 5. 369, P = 0. 020）. Conclusions Laparoscopy is a good choice for cholelithotomy with the gallbladder being preserved, for it is minimally invasive, and thus leads to less surgical trauma, quicker recovery, fewer complications, and shorter hospital stay after the procedure.