二孔与三孔腹腔镜辅助胆道镜保胆取石术临床比较研究

Clinical Comparative Study of Two Holes and Three Holes Laparoscopic-assisted Choledochoscopic Cholecystolithotomy

目的比较二孔腹腔镜辅助胆道镜保胆取石术与三孔腹腔镜辅助胆道镜保胆取石术的优缺点,探讨其临床应用的可行性、优越性及手术技巧。方法 2009年1月至2010年2月由同一术者手术,二孔腹腔镜辅助胆道镜保胆取石术(二孔组)38例,三孔腹腔镜辅助胆道镜保胆取石术(三孔组)40例,回顾性对比分析两组手术时间、术中出血量、术后肠蠕动恢复时间、术中术后并发症等。结果两组病例在年龄、性别、病情等方面的构成无显著差异,三孔组术中术后未发现明显并发症,而二孔组发生术中胆囊床撕裂出血1例(2.6%),术后继发性胆管结石3例(7.9%),术后胰腺炎2例(5.3%),并发症总发生率为15.8%(6/38),明显高于三孔组(P=0.01),手术时间、术中出血量、术后肠蠕动恢复时间两组差异无统计学意义(P>0.05)。结论三孔腹腔镜辅助胆道镜保胆取石术安全可行,具有一定的临床推广价值。

Objective To discuss the advantages and disadvantages of two holes or three holes laparoscopic-assisted choledochoscopic cholecystolithotomy,and to explore the possibilities,superiority and surgical technique of their clinical applications.Methods The clinical data of 38 patients with two holes laparoscopic-assisted choledochoscopic cholecystolithotomy（two holes group） and 40 patients with three holes laparoscopic-assisted choledochoscopic cholecystolithotomy（three holes group） performed by the same surgeon between January 2009 and February 2010 were retrospectively analyzed.The operation time,bleeding volume,enterokinesia recovery time and complications were compared between two groups.Results The differences of the operation time,the enterokinesia recovery time and bleeding volume between two groups were not significant in statistics.There was no severe complication in the three holes group,but in the two holes group,1 patient suffered from the biliary haemorrhage caused by the gallbladder bed laceration,3 patients from secondum common duct stones and 2 from acute pancreatitis.The complication rate was much higher in the two holes group（P=0.01）.Conclusion Three holes laparoscopic-assisted choledochoscopic cholecystolithotomy is a safe,efficient and feasible procedure.