腹腔镜手术与开腹手术治疗胆总管结石的疗效比较

Comparism of therapeutic effects between Laparoscopic and open surgery on choledocholithiasis

目的比较腹腔镜胆总管切开取石术与开腹手术治疗胆总管结石的临床效果。方法将46例胆总管结石患者按住院先后随机分为腹腔镜组21例和开腹手术组25例，比较的手术时间、住院时间、肛门排气时间、术后使用止痛剂、手术出血量和术后并发症等情况。结果腹腔镜组住院时间（10．5±2．4）d、胃肠功能恢复时间（27．2±9．4）h、术后使用止痛剂率（28．6％）与开腹手术组的（14．3±2．5）d、（54．6±12．5）h、88．0％，比较差异有统计学意义（t=2．03、1．98，x^2=16．92，均P〈0．05），而两组的手术时间和术中出血量比较差异无统计学意义（t=1．76、1．89，均P〉0．05）。腹腔镜组切口感染率（0％）较开腹组（24．0％）低（x^2=3．87，P〈0．05），两组均无胆漏、结石残余、腹腔感染等发生。结论腹腔镜胆总管切开取石术是安全、有效、可行的，与开腹手术相比具有创伤小、痛苦轻、术后恢复快，并发症少等优点。

Objective To compare the therapeutic effects of laparoscopie and open surgery treatment for choledocholithiasis. Methods Forty-six cases with choledocholithiasis were randomly divided into laparoscopic surgery group（ n = 21 ） and open surgery group（ n = 25 ）. Comparison was conducted between the two groups in terms of operative time, hospitalization day, anorechlnl exhaust time, cases of postoperative pain, the amount of intraoperative bleeding and postoperative complications. Results Hospitalization day （ 10. 5 ± 2. 4d）, anorechlnl exhaust time （ 27.2 ± 9.4h） ,cases of postoperative pain（28. 6% ） in the laparoscopic surgery group were significantly better than those in open surgery group（ 14. 3 ±2. 5d,54. 6 ± 12. 5h,88.0% ） （P〈0.05）. The operative time and the amount of intraoperative bleeding was not significantly different between two groups （ P 〉 0. 05 ）. The rate of infection of incisional wound in the laparoscopic surgery group （0%） was lower than that of open surgery group 24. 0% （P 〈 0. 05 ）. No residual calculi and bile leakage were found in beth groups. The other postoperative complications were not significantly different between the two groups （ P 〉 0. 05 ）. Conclusion Laparoscopie eholedocholithotomy is safe, effective and feasible. Compare with open surgery,it is a less invasive proceduee for the treatment of choledocholithiasis with the virtue of little trauma ,fast recovery, short hospitalization days and few complication.