以外科手术为主的3种不同方式治疗胆囊结石的疗效对比分析

The curative effect analysis of 3 different surgical ways for gallstone treatment

目的探讨以外科手术为主的3种不同方式治疗胆囊结石,对比分析多项指标,评价3种治疗方式的临床效果。方法 233例胆囊结石患者根据制定的人选标准,共分成3组:腹腔镜胆囊切除术(LC)组50例,对照Ⅰ组91例,对照Ⅱ组92例。对照Ⅰ组和对照Ⅱ组行内镜微创取石保胆术,对照Ⅱ组在对照Ⅰ组基础上,术后第2日起加用自制的中药利胆护胆汤。3组术后均给予消炎、对症治疗,术后每3个月随访一次。临床效果评价指标包括手术时间、术中出血量、胆漏、胆总管损伤、反流性胃炎食管炎、胆总管结石复发率等10项指标。结果 LC组和内镜微创保胆取石术均未发现胆总管损伤且在手术时间上没差异。但在手术出血量、胆漏、术后患者的消化功能、反流性食管炎、胆总管结石发生率5个指标上,内镜微创保胆取石术优于LC;内镜微创保胆取石术2年后,对照Ⅱ组的胆囊壁厚度、胆囊收缩功能、胆囊结石复发率优于对照Ⅰ组。结论内镜微创取石保胆手术治疗胆囊结石,其手术出血量、术后消化道症状和并发症较LC少。术后加用中药护胆治疗,能降低胆囊结石复发率,具有较好的应用前景。

【Objective】To investigate the surgical operation based on 3 different ways for the treatment of cholecystolithiasis and evaluate the multiple indexes and 3 kinds of treatment clinical effect. 【Methods】233 cases of patients with gallbladder stones according to established criteria for inclusion, were divided into three groups: Laparoscopic cholecystectomy (LC) group in 50 cases, control group of 91 cases, control group of 93 cases. Control group one and group two rows of minimally invasive endoscopic stone extraction and biliary surgery, according to Ⅰ group in Ⅱ according to groups based on the second postoperative day, with homemade medicine Lidan protecting gallbladder decoction. After operation, the 3 groups were given anti-inflammatory, symptomatic treatment, postoperative follow up once every March. Clinical effect evaluation index included operation time, intraoperative bleeding,bile leakage, bile duct injury, reflux esophagitis, common bile duct stone recurrence rate of 10 indexes.【Results】In the LC group and minimally invasive endoscopic gallbladder-reservation found no common bile duct injury in the operation and time difference.But in the operation the amount of bleeding, bile leakage, postoperative patients with digestive function, reflux esophagitis, common bile duct stone incidence on 5 index, endoscopic minimally invasive cholecystolithotomy was superior to LC; Endoscopic minimally invasive cholecystolithotomy after 2 years, the control group Ⅱ of the gallbladder wall thickness, the contraction function of gallbladder, gallbladder stone recurrence rate were better than the control group. 【Conclusion】Minimally invasive endoscopic stone extraction and biliary operation in treatment of cholecystolithiasis, its operation bleeding volume, postoperative gastrointestinal symptoms and complications was less than LC. Postoperative nursing of biliary treatment with Chinese medicine, can reduce gallbladder stone recurrence rate, and has better application prospect.