完全腹腔镜与小切口保胆取石(/息肉)术的疗效比较

Effect Comparison between Completely Laparoscopic and Small Incision Cholecystolithotomy and Polypectomy with Gallbladder-preserving

目的观察比较完全腹腔镜与小切口开腹保胆取石（/息肉）术治疗胆囊结石、胆囊息肉的疗效及安全性。方法回顾性分析我院2010年1月-2012年12月行保胆取石（/息肉）术的82例患者,其中完全腹腔镜下保胆取石（/息肉）术（41例）及小切口开腹保胆取石（/息肉）术（41例）,比较两组手术时间、术中出血量、术后首次肛门排气时间、住院时间及并发症发生情况。结果两组患者均顺利完成手术,无中转腹腔镜胆囊切除术或开腹手术。完全腹腔镜组手术时间平均（62.7±15.2）min,小切口组平均（57.5±13.8）min,两组手术时间比较无统计学差异（P〉0.05）。完全腹腔镜组术中出血量、术后首次肛门排气时间及住院时间分别为（7.1±1.5）ml、（16.7±4.2）h和（5.5±0.6）d,小切口组分别为（9.8±2.0）ml、（24.5±4.8）h和（8.7±0.8）d,组间比较差异均具有统计学意义（P≤0.05）。两组患者均未出现胆漏、出血等并发症。术后完全腹腔镜组出现胆囊区积液1例;小切口组出现右侧肝肾隐窝积液1例,切口感染1例,两组术后并发症发生率比较差异无统计学意义（P〉0.05）。均获随访1年,B超检查示胆囊结构正常,未出现结石（/息肉）复发病例。结论完全腹腔镜下保胆取石（/息肉）术治疗胆囊结石、胆囊息肉具有创伤小、恢复快、术后并发症少等优势,值得临床推广。

Objective To compare the safety and effect of completely laparoscopic and small incision cholecystolithotomy and polypectomy with gallbladder-preserving. Methods The clinical data of 82 patients with cholecystolithiasis or gallbladder polyps admitted from January 2010 to December 2012 were analyzed retrospectively. 41 patients regarded as the laparoscopic group were performed completely laparoscopic cholecystolithotomy or polypectomy with gallbladder-preserving, 41 patients regarded as the small incision group were performed minilaparotomy of cholecystolithotomy or polypectomy with gallbladder-preserving. The operation time, intra-operative blood loss, the gastrointestinal recovery time, post＇operative hospital stays and post-operative complications rate were compared between two groups. Results The 82 operations were successfully accomplished without conversion to laparoscopic cholecystectomy or laparotomy. There was no statistic difference in operative duration between two groups （62.7 ± 15.2 VS 57.5 ± 13.8, P 〉0.05）. The intra-operative blood loss, the first exhaust time and hospital stays was 7.1 ± 1.5 ml, 16.7±4.2 h and 5.5 ＋0.6 d in the laparoscopic group respectively, and was 9.8 ± 2.0 ml, 24.5 ± 4.8 h and 8.7 ± 0.8 d in the small incision group respectively, and there was remarkably statistic difference between two groups （ P ≤ 0.05 ）. No gallbladder leaking and hemorrhage occurred. The gallbladder area effusion was found in 1 case of the laparoscopic group, and the post-operative incision infection and hepatorenal recess hydrops were found in 1 case respectively in the small incision group. There was no statistical difference in post-operative complication rate between two groups （ P 〉 0.05 ）, All cases were followed-up for 1 year. The ultrasonography examination showed normal structure of gallbladder and no recurrence of gallbladder stone or polyps. Conclusion The completely laparoscopic cholecystolithoto- my and polypectomy with gallbladder-preserving is an effective surgery for cholecystolithiasis and gallbladder polyps with advantages as mini-trauma, faster recovery and less post-operative complication, and it is worthy of clinical popularization.