腹腔镜辅助胆道镜、完全腹腔镜及开腹手术治疗胆石症的对比研究

Comparison study on laparoscopic-assisted choledochoscope,laparoscope and laparotomy in the treatment of cholelithiasis

目的探讨腹腔镜联合胆道镜、完全腹腔镜及传统开腹手术治疗胆石症的效果。方法 2008年1月～2011年6月我院择期治疗的胆石症患者90例根据治疗方法不同分为三组,微创联合组(28例)采取腹腔镜辅助胆道镜治疗;完全腹腔镜组(31例)采取完全经腹腔镜手术治疗;传统手术组(31例)采取传统开腹手术治疗。结果三组患者均手术成功,无死亡。与传统手术组相比,微创联合组及完全腹腔镜组手术时间明显缩短[(68.0±2.0)、(53.0±6.0)、(62.0±4.0)min,P<0.05]。微创联合组及完全腹腔镜组术中出血量少于传统手术组[(10.0±2.0)、(9.0±2.8)、(18.0±3.2)mL,P<0.05)。同时,结石取净率在微创联合组、完全腹腔镜组及传统手术组分别为100%、93%、100%,差异无统计学意义(P=0.109)。三组术后均无并发症发生。结论腹腔镜辅助胆道镜,完全腹腔镜及传统开腹手术均可安全有效的治疗胆石症,但腹腔镜辅助胆道镜治疗创伤小,更利于患者恢复健康。

Objective To compare the effectiveness of laparoscopic-assisted choledochoscope,laparoscope and laparotomy in the treatment of cholelithiasis.Methods 90 patients with cholelithiasis in our hospital from January 2008 to June 2011 were divided into three groups： minimally invasive joint group（n = 28） was given laparoscopic-assisted choledochoscope;laparoscope group（n = 30） was given laparoscopic surgery;laparotomy surgery group（n = 31） was given open surgery.Results There was no deaths occurred with all successful operation,Compared with laparotomy surgery group,the operation time in minimally invasive joint group and laparoscope group reduced obviously [（68.0±2.0）,（53.0±6.0）,（62.0±4.0） min respectively,P 0.05],and the operating hemorrhage of minimally invasive joint group and laparoscope group were lower than that of laparotomy surgery group [（10.0±2.0）,（9.0±2.8）,（18.0±3.2） mL respectively,P 0.05].At the same time,the clear rate of biliary calculus were 100% in minimally invasive joint group,93% in laparoscope group and 100% in laparotomy surgery group（P = 0.109）.There was no complication in the three groups.Conclusion All the aparoscopic-assisted choledochoscope,laparoscope and laparotomy are efficient therapy in the treatment of cholelithiasis,but laparoscopic-assisted choledochoscope had less injuries and is much beneficial for the recovery of patients.