小切口胆总管探查术安全性及疗效评估的随机对照研究

Randomized controlled study of safety and curative effect of the mini-incision exploration of common bile duct

目的系统评价小切口胆总管探查术的安全性、可行性以及疗效。方法采用前瞻性随机对照方法，分别对290例小切口和120例传统切口行胆总管探查术的病人，就术中意外伤、术后并发症、结石残留、术后一般情况和预后等临床资料进行对比分析。结果手术时间、术中出血量、术后血浆管引流量、术后肠功能恢复时间、下床活动时间、住院时间等，小切口组少于传统切口组；小切口组术中意外损伤发生率为1．72％（5／290），术后结石残留率为3．45％（10／290），结石复发率为5．18％（15／290）；传统切口组术中意外损伤发生率为1．67％（2／120），术后结石残留率为3．33％（4／120），结石复发率为5．0％（6／120），统计显示两组差异无显著性（P〉0．05）；小切口组术后发生并发症17例，传统组为16例，两组比较有统计学差异（P〈0．05）。结论小切口胆道探查手术是一种安全、有效、预后良好、恢复时间快的手术方式。

Objective To evaluate the safety, feasibility and curative effect of mini-incision exploration of common bile duct. Methods In this study, 290 patients underwent min-incision exploration of common bile duct and 120 patients underwent open-incision exploration of common bile duct for bile duct stones and/or gallstones from 2005 to 2007. The iatrogenic bile duct injury, postoperative complication, residual stone, stone recurrence, therapeutic effect and clinical data were evaluated by randomized contrast analysis. Results Time of operation, bleeding, volume of drain pipe, time of recovery of intestinal peristalsis and average duration in hospital were significantly lower in the group of min-incision exploration（MCE） than in the group of open-incision exploration（OCE）. The iatrogentic bile duct injury occurred in 5 cases （1.72%）, residual stone in 10 cases （3. 452%）, stone recurrence in 15 cases（5.182%） in the group of MCE, and in 2 cases（1.672%）, 4 cases （3.332%） and 6 cases respectively in the group of OCE. There was no marked difference between the two groups. However, postoperative complications occurred in 17 cases （6.82%） and 16 （13.32%） in the group of MCE and OCE, respectively. There was remarkable difference between the 2 groups （P〈0.05）. Conclusion Mini-incision exploration of common bile duct is a feasible and safe method resulting in fewer complications of iatrogentic bile duct injury, stone recurrence and residual stone.