胆囊结石并肝硬化患者行腹腔镜与开腹胆囊切除术的对比研究

Comparative study of gallbladder stones and liver cirrhosis underwent laparoscopic gallbladder resection

目的比较腹腔镜胆囊切除术与开腹胆囊切除术治疗胆囊结石并肝硬化的临床疗效。方法回顾分析本院2009年6月～2011年6月收治的胆囊结石并肝硬化患者76例,将其按照手术方式不同分为腹腔镜胆囊切除术组和开腹胆囊切除术组各38例,腹腔镜胆囊切除术组患者采用常规四孔法,常规建立气腹,取头高脚低左侧倾斜体位,术中维持气腹压11～12 mmHg;开腹胆囊切除术组患者在右肋缘下做切口行胆囊切除术。治疗结束后比较两组的平均手术时间、术中平均出血量、平均住院时间及胆总管损伤发生情况。结果腹腔镜胆囊切除术组的平均手术时间、术中平均出血量、平均住院时间及手术胆总管损伤发生率均较开腹胆囊切除术组低,两组比较,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术治疗胆囊结石并肝硬化较开腹胆囊切除术优势明显,具有创伤小、手术时间短、术后康复快、并发症少等优点,安全可靠,值得临床推广应用。

Objective To compare the clinical efficacy of laparoscopic cholecystectomy and open cholecYstectomy in the treatment of gallbladder stones and liver cirrhosis. Methods Seventy-six patients with gallstone and liver cirrhosis from June 2009 to June 2011 were analyzed, and were divided into laparoseopic resection group and cholecystectomy surgery group of 38 cases in each group, abdominal mirror choleeysteetomy patients were treated with the conventional four-hole method, conventional establishment of pneumoperitoneum, took first tall low left side of tilt position,technique to maintain gas abdomi- nal pressure in patients with 11-12 mmHg; open eholecystectomy group under the right costal margin did incision cholecys- tectomy. After treatment, the average operative time, intraoperative draw bleeding volume, average length of stay and surgi- cal complications of the two groups were compared. Results The average operative time for laparoscopic resection group, the mean amount of bleeding, the average length of stay and common bile duct injury rate compared with open eholecystee tomy surgery group, the difference was statistically significant （P 〈 0.05）. Conclusion Laparoscopic cholecystectomy in the treat ment of gallbladder stones and liver cirrhosis compared with open cholecystectomy have obvious advantages, with less trauma, shorter operative time, quick recovery, fewer comolications.the advantages of ~afe. r^li^hl~ w.rthv .f ol;n;~l on^l;~;~