不同腹腔镜术式治疗胆囊结石合并胆总管结石临床疗效分析

Effective Analysis of Different Types of Laparoscopic Surgical Treatment on Cholecystolithiasis and Common Bile Duct Stones

目的探讨两种腹腔镜术式治疗胆囊结石合并胆总管结石的手术疗效.方法回顾性分析2006年11月至2012年11月采用腹腔镜微创治疗胆囊结石合并胆总管结石98例患者的临床资料,分为腹腔镜胆道探查T管引流组52例(A组),腹腔镜经胆囊管胆道探查组46例(B组),比较2组间患者的手术时间、手术出血量、手术并发症、术后住院天数、住院费用等差异.结果 A组手术时间、手术出血量、术后腹腔引流时间、术后住院日及住院费用显著长于或高于B组(P<0.05);A组15.4(8/52)和B组13(6/46)手术并发症比较差异无统计学意义(P>0.05).结论在严格掌握适应证的前提下,经胆囊管途径腹腔镜胆道探查术与腹腔镜胆道探查T管引流术相比微创优势明显,安全、可靠,患者术后恢复快,是治疗胆囊结石合并胆总管结石病人优选方法,而传统的胆管切开T管引流是必要的补充方式.

Objective To investigate surgical effects of two kinds of laparoscopic surgical treatment on chole- cystolithiasis and choledocholithiasis. Methods The clinic data of 98 patients with cholecystolithiasis and choledo- cholithiasis surgically treated with minimally invasive laparoscopy in the past six years were analyzed retrospectively. The patients were divided into two groups. Group A （52 patients） was treated with laparoscopic common bile duct exploration with T-tube drainage and group B （46 patients） was treated with laparoscopic common bile duct explo- ration via cystic duct. The operation time, blood loss, surgical complications, postoperative hospital stay and hos- pital cost were compared between the two groups. Results The operation time, blood loss, postoperative peritoneal cavity drainage time, hospital stay and hospital cost in group A were significantly longer or higher than those in group B （P〈 0.05） . There was no significant difference in surgical complications between the two groups, with 15.4% in Group A and 13.0% in Group B （P 〉 0.05 ）. Conclusion Under the strict control of indications, laparoscopic common bile duct exploration surgery via cystic duct pathway was superior to laparoscopic common bile duct explo- ration with T-tube drainage in terms of its minimal invasion, safety, reliability, quick postoperative recovery. It is a preferred method to treat patients with cholecystolithiasis and choledocholithiasis, and the traditional choledochoto- my with T-tube drainage is a necessary complement way.