腹腔镜胆总管探查术的临床评价

Clinical value of laparoscopic common bile duct exploration

目的:探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)的临床疗效。方法:回顾分析2011年4月至2013年3月,我院34例行LCBDE、46例行开腹胆总管探查(open common bile ductexploration,OCBDE)加胆囊切除术和22例行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)联合腹腔镜胆囊切除(laparoscopic cholecystectomy after ERCP,ERCP+LC)的临床资料。结果 :LCBDE组与OCBDE组相比,手术时间短(82.7 min比114.1 min,P<0.01),术中出血少(27.6 mL比80.8 mL,P=0.041),术后排气时间短(1.3 d比3.0 d,P<0.01),住院时间短(10.5 d比17.6 d,P<0.01),住院费用低(21 653.4元比30 497.7元,P=0.023)。LCBDE组病人术后并发症发生率显著低于ERCP+LC组(2.9%比31.8%,P<0.01)。LCBDE组住院时间及住院费用与ERCP+LC组相比无统计学差异(10.5 d比13.9 d,P>0.05;21 653.4元比25 860.7元,P>0.05)。结论:LCBDE具有痛苦小、创伤轻、恢复快、安全可靠等优点,能缩短住院时间,降低医疗费用。

Objective To study the clinical value of laparoscopic common bile duct exploration （LCBDE）. Methods We retrospectively reviewed the clinical data of 34 cases underwent LCBDE, including laparoscopic cholecystectomy（LC） 46 cases underwent open common bile duct exploration（OCBDE） and 22 cases underwent LC after ERCP （ERCP＋LC） from Apr 2011 to Mar 2013. Results Comparing with OCBDE, operative times of LCBDE was shorter （82.7 rain vs 114.1 min, P〈0.01）, with less blood loss （27.6 mL vs 80.8 mL, P=0.041）, shorter postoperative passing flatus （1.3 d vs 3.0 d, P〈0.01）, shorter hospital stay （10.5 d vs17.6 d, P〈0.01） and lower medical cost （ 21 653.4 yuan vs 30 497.7 yuan, P=0.023）. But compared with ERCP＋LC group, the LCBDE group presented the lower rate of postoperative morbidity （2.9% vs 31.8%, P〈0.01）. There was no statistically significant difference in hospital stay（10.5 d vs 13.9 d, P〉0.05）, medical cost （21 653.4 yuan vs 25 860.7 yuan, P〉0.05）. Conclusions LCBDE is safe and reliable which has the advantage of less pain, less trauma and faster to recovery. It can shorten the duration of hospital stay and decrease the medical cost.