摘要
目的探讨腹腔镜、胆道镜联合加减大柴胡汤治疗二、三期胆道残余结石的可行性。方法将75例二、三期胆道结石患者随机分为3组,每组25例。Ⅰ组予以常规开腹手术治疗,Ⅱ组予以腹腔镜、胆道镜联合治疗,Ⅲ组予以腹腔镜、胆道镜联合加减大柴胡汤治疗。观察3组治疗后患者术中手术时间、术中胃肠或胆管损伤例数、术后肛门排气时间、术后体温恢复正常时间、术后腹腔引流管留置时间、术后残余或继发胆管结石例数、术后胆漏发生率、术后肠黏连肠梗阻例数、术后住院时间等。结果3组患者75例均治愈出院,Ⅰ组病例,术中平均手术时间(120.43±19.05)min,平均出血(93.66±27.6)ml,无胃肠、胆管损伤及胆漏发生,术后切口感染2例,平均肛门排气时间(56.5±5.95)h,体温恢复正常时间(76.6±10.68)h,腹腔引流管留置时间(7.5±1.17)d,术后平均住院时间(12.8±0.74)d,术后进食后出现腹胀3例、便秘2例、腹泻1例;术后残余肝胆管结石7例,继发胆管结石5例,术后肠黏连肠梗阻2例;Ⅱ组病例,术中平均手术时间(94.63±19.21)min,平均出血(73.57±27.38)ml,无胃肠、胆管损伤及胆漏发生,中转开腹1例,平均肛门排气时间(37.03±3.9)h,体温恢复正常时间(70±6.10)h,腹腔引流管留置时间(5.43±1.08)d,术后平均住院时间(7.4±0.55)d,术后进食后出现腹胀2例、便秘1例、腹泻1例;继发胆管结石3例;Ⅲ组病例术中平均手术时间(94.33±19.11)min,平均出血(73.75±27.83)ml,无胃肠、胆管损伤及胆漏发生,中转开腹1例,平均肛门排气时间(35.03±3.39)h,体温恢复正常时间(61±6.10)h,腹腔引流管留置时间(5.14±1.28)d,术后平均住院时间(7.1±0.45)d,术后进食后出现腹胀1例、便秘0例、腹泻1例;术后无明显并发症发生。结论腹腔镜、胆道镜联合加减大柴胡汤治疗二、三期胆道残余结石,在临床上可行,值得推广应用。
Objective To discuss effects of laparoscopic,choledochoscope joint addition and subtraction big bupleurum decoction "in the treatment of two,three stage biliary residual stones feasibility.Methods 75 patients with two,three stage biliary calculi were randomly divided into three groups,each grouphad 25 cases.Ⅰ group were taken conventional open surgery treatment,Ⅱ group were taken laparoscopic,choledochoscope combination therapy,Ⅲ group were taken laparoscopic,choledochoscope joint addition and subtraction big bupleurum decoction.To observe three groups after treatment,the patients during the operation,the operation time,intraoperative gastrointestinal or bile duct injury number,postoperative anal exhaust time,the body temperature to restore normal time,postoperative abdominal cavity drainage tube indwelling time,postoperative residual or secondary biliary calculi number,postoperative bile leakage rate,postoperative intestinal adhesion ileus number,postoperative hospital stay,etc.Results Three groups of patients in 75 cases were cured and discharged,Ⅰ group,intraoperative average operation time was(120.43 ± 19.05)min,the average bleeding(93.66 ± 27.6) ml,no gastrointestinal,bile duct injury and bile leakage occurs,postoperative incision infection in 2 cases,average anal exhaust time(56.5±5.95)h,the body temperature to restore normal time(76.6 ±10.68) h, abdominal cavity drainage tube indwelling time(7.5±1.17) d,the average length of hospital stay(12.8 ± 0.74)d,postoperative abdominal distension after eating in 3 cases,2 cases of constipation,diarrhea 1 case.The postoperative residual bile duct stones in 7 cases,5 cases of secondary bile duct stones,postoperative intestinal adhesion intestinal obstruction 2 cases;Ⅱ group,intraoperative average operation time was(94.63±19.21) min,the average bleeding(73.57±27.38) ml,no gastrointestinal,bile duct injury and bile leakage occurs,transit operation in 1 case,average anal exhaust time(37.03 ±3.9) h,the body temperature to restore normal time(70 ± 6.10) h,abdominal cavity drainage tube indwelling time(5.43 ±1.08)d,the average length of hospital stay(7.4 ±0. 55) d,postoperative abdominal distension after eating in 2 cases,1 case with constipation,diarrhea 1 case.3 cases of secondary bile duct stones.Ⅲ group was intraoperative average operation time(94.33 ± 19.11) min,the average bleeding(73.75 ± 27.83)ml, no gastrointestinal,bile duct injury and bile leakage occurs,transit operation in 1 case,average anal exhaust time(35.03 ± 3.39)h, body temperature to restore normal time(61 ± 6.10)h,abdominal cavity drainage tube indwelling time(5.14 ± 1.28)d,the average length of hospital stay(7.1 ± 0.45)d,postoperative abdominal distention after eating 1 cases,0 ceses of constipation,diarrhea in 1 patients;no obvious postoperative complication.Conclusion Laparoscopic,choldochoscope joint addition and subtraction big bupleurum decoction in the treatment of two,three stage biliary residual stones,may be clinically feasible,worthy of popularization and application.
出处
《江西医药》
CAS
2013年第1期11-14,共4页
Jiangxi Medical Journal
关键词
腹腔镜
胆道镜
大柴胡汤
胆道(残余)结石
临床疗效观察
Laparoscopic
Choledochoscope
Big bupleurum soup
Bliary tract(residual) stone
Clincal curative effect observation