开腹与腹腔镜胆总管切开取石术的对比研究

The Comparative Study of Choledocholithotomy by Operation and Laparoscope

目的:对比传统开腹手术治疗胆总管结石与腹腔镜下手术治疗胆总管结石的临床效果。方法:回顾性分析2009年1月至2012年12月皖南医学院附属弋矶山医院收治入院的41例腹腔镜胆总管切开探查取石术(1aparoscopic common bile duct exploration,LCBDE),与同期45例开腹胆囊切除胆总管切开取石、T管引流术(Open choledocholithotomy T-tube drainage OCHTD)患者的临床资料。结果:两组病人均治愈出院。LCBDE组术中出血量、术后肠道功能恢复时间、第1次下床活动时间、术后总并发症发生率、术后住院天数、总住院天数均少于OCHTD组,两组比较差异有统计学意义(P<0.05),两组病人的手术时间差异并无统计学意义(P>0.05),虽然LCBDE组住院费用略高于OCHTD组,但差异无统计学意义(P>0.05)。结论:LCBDE创伤小,并发症发生率低,住院时间短,胆囊结石、胆总管结石可一次手术治疗,术中术后出血少,肠道功能恢复时间短,患者康复快,疗效满意,具有广阔的应用前景,有望成为治疗胆囊结石并发胆总管结石的首选治疗方法。

Objective： To compare the clinical effects of laparoscopic common bile duct exploration （LCBDE） with open choledocholithotomy T-tube drainage （OCHTD）.Method： 41 cases of laparoscopic common bile duct exploration （ LCBDE） who were admitted to Yijishan hospital of Wannan Medical College from January 2009 to December 2012, and 45 cases of open choledocholithotomy T-tube drainage （ OCHTD） in the same period were collected .And comparative analysis of the clinical data for above patients were car-ried out.Result：Both groups of patients were cured.In the LCBDE group, intraoperative blood loss, postop-erative intestinal function recovery time , 1st ambulation time , postoperative wound infection , and hospital stay were less than those in OCHTD group , the difference was statistically significant （ P＆lt;0.05） .The differ-ence of patients surgery time was not statistically significant （ P＆gt;0.05） .Although hospital costs of LCBDE group were little higher than that of the OCHTD group , the difference was not statistically significant （ P＆gt;0. 05）;postoperative biliary leakage , abdominal abscess complications and stone clearance rate had no signifi-cant difference （ P＆gt;0.05） .Conclusion：LCBDE is with lower operative damage , less complications , shorter hospital stay;the gallstones , common bile duct stones can be solved by one surgical treatment , intraoperative and postoperative blood loss is less , intestinal function recovery time is shorter .Patients recovered quickly , the results are satisfactory .It is with a broad application prospects , promising well as a treatment of choice for＆amp;nbsp;the gallstones with choledocholithiasis .