保胆取石术式选择临床研究

Clinical study for the choice of minimally invasive cholecystolithotomy

目的:比较目前常用保胆取石术式的优缺点。方法:将2009年7月至2012年7月符合保胆条件的胆囊结石患者150例随机分为3组(每组50例),分别接受腹腔镜辅助体外胆道镜保胆取石术(组1),完全腹腔镜下保胆取石术(组2)或传统胆道镜保胆取石术(组3)。术后予牛磺熊去氧胆酸胶囊口服半年,定期随访。比较各组手术时间,术后并发症发生率,住院时间,住院费用和结石复发率。结果:3组均无结石复发。组1所有患者术后均恢复良好,其手术时间和并发症发生率较之组2显著减少,住院时间较之组3显著缩短(P<0.05)。结论:腹腔镜辅助体外胆道镜保胆取石术相对于其他两种术式具有手术时间短,术后恢复快,并发症发生率低的优点,值得临床推广。牛磺熊去氧胆酸胶囊可有效预防结石复发。

Objective：To compare the strong and weak points of different operative methods of minimally invasive cholecystolithoto- my. Methods： From July 2009 to July 2012 ,a number of 150 patients with eholecystolithiasis were randomly divided into 3 groups （50 cases each）. Patients in Group 1 underwent minimally invasive cholecystolithotomy by using laparoscopy with the assistant of external choledochoscope. Patients in Group 2 underwent the operation by laparoscopy,while patients in Group 3 underwent the operation by tra- ditional eholedochoscope only. Tauro-ursodesoxycholie acid was prescribed to prevent calculus recurrence. The follow-up visits were performed in the patients regularly. The time of operation, time and cost of hospitalization and the incidence of complication and calculus recurrence were compared. Results： There was no calculus recurrence. Patients in Group I recovered well. The time of operation and the incidence of complication in Group 1 were significantly lower than those in Group 2,while the time of hospitalization in Group 1 was significantly shorter than that in Group 3 （P 〈 0.05 ）. Conclusion： Minimally invasive cholecystolithotomy by using laparoscopy with the assistant of external choledochoscope is superior to the other two kinds of operations. It is worth of generalization in clinics. Tauro- ursodesoxyeholic acid is useful in prevention of calculus recurrence.