LCBDE治疗胆囊结石并胆管结石的疗效分析

Comparative Analysis of LCBDE and OCBDE in Treating Cholecystolithiasis and Choledocholithiasis

目的:探讨腹腔镜胆总管探查取石术(LCBDE)的常见并发症及其防治,比较LCBDE与开腹胆总管探查术(OCBDE)两种手术方式的疗效及机体应激反应的大小。方法:收集2002年1月—2010年6月山西省太钢总医院收治的胆囊结石并胆总管结石780例患者资料,其中实施OCBDE598例,实施LCBDE182例。参照LCBDE患者的年龄、性别、疾病类型、疾病程度等因素,在OCBDE患者中选取52例,进行配对研究。术前及术后第1天晨、术后第2天晨采取血样,检测血浆C-反应蛋白(C-reactiveprotein,CRP)。结果:LCBDE与OCBDE两组患者的取石成功率、手术用时差异无统计学意义(P>0.05),LCBDE组的术中失血量、肠功能恢复时间、术后住院时间明显少于OCBDE组,差异有统计学意义(P<0.05)。术后两组患者的血浆CRP均升高,与术前比较差异有统计学意义(P<0.05);血浆CRP在术后第1天的实验室检查结果提示:OCBDE组明显高于LCBDE组,两组间比较均差异有统计学意义(P<0.05)。结论:LCBDE是合理、有效的手术方式,具有创伤轻,痛苦小,恢复快的优点;CRP的研究分析进一步证实LCBDE术后应激反应小于OCBDE,说明LCBDE具有微创手术的优势,可望取代绝大多数OCBDE手术。

Objective：To explore the application of LCBDE in common bile duct exploration and removing the stone,prevention and cure for concerning complications and compare the curative effects and the size of surgery wound between LCBDE and OCBDE.Methods：From 2002 to 2010,the patients with cholecystolithiasis and choledocholithiasis treated were devided into two groups：LCBDE and OCBDE group.In reference to the age,sex,disease type,disease extent,follow up data and other factors of patients,52 pairs of cases are selected to be researched.Taking surgery time,operative blood loss,calculi removal rate,postoperative recovery time of intestine function and postoperative hospital stay as comparative indexes.Plasma CRP should be tested on the first and second postoperative mornings.Results：There was no great difference in calculi removal rate and surgery time between LCBDE and OCBED（P0.05）.Operative blood loss,recovery time of intestine function and postoperative hospital stay in LCBDE group were apparently less than those in OCBDE group（P0.05）.Plasma CRP after surgery were increased in both groups and greatly different from preoperational indexes（P0.05）.Laboratory test results at the first postoperative day had shown that Plasma CRP in OCBDE was distinguishingly more than that in LCBDE（P0.05）.Conclusion：LCBDE is a rational and effective surgery,and has the strength of mild wound,less pain and recovering soon.The research and analysis of CRP has further proved that LCBDE has a slighter postoperative stress operation than OCBDE,which indicates that LCBDE has the advantages of minimal invasive surgery and can replace most of OCBDE surgeries.