腹腔镜下微创手术治疗单纯性胆囊结石的临床疗效分析

Clinical Efficacy of Laparoscopic Minimally-invasive Surgery for Gallbladder Stone

目的了解腹腔镜保胆取石术和腹腔镜胆囊切除术治疗单纯性胆囊结石的优缺点。方法选取2007年1月-2011年12月在微创外科就诊的148例单纯胆囊结石患者为研究对象,分别就腹腔镜保胆取石术治疗（观察组,n=68例）和腹腔镜胆囊切除术治疗（对照组,n=80例）方式及效果进行分析,比较两组患者的手术成功率、结石取净率、手术时间、术中出血量、术后肠蠕动恢复时间、住院时间、术后并发症及随访情况。结果观察组手术成功率为100.0%（68/68）,对照组为98.8%（79/80）,两组结石取净率均为100%。术后2周B型超声检查,观察组患者的胆囊壁均光整无增厚,胆囊收缩率均〉30%。观察组和对照组的手术时间分别为（49.6±5.2）、（50.5±6.2）min,出血量分别为（9.5±1.4）、（50.2±8.1）mL,手术时间差异无统计学意义（P〉0.05）,出血量两组差异有统计学意义（P〈0.05）;观察组和对照组术后肠蠕动恢复时间分别为（33.9±2.2）、（34.4±2.6）min,住院时间分别为（3.4±1.0）、（3.6±1.2）d,两组比较差异无统计学意义（P〉0.05）;两组术后均无出血、胆瘘、切口感染等并发症发生。门诊随访6～12个月,均无结石复发;观察组37例患者随访3年,仅有1例（2.7%）出现胆囊结石复发。结论腹腔镜保胆取石术和腹腔镜胆囊切除术治疗单纯性胆囊结石均安全可行,但前者不仅保全了胆囊,而且具有术中出血少等优点。

Objective To investigate and compare the advantages and disadvantages of laparoscopic cholecystolithotomy and laparoscopic cholecystectomy for patients with gallbladder stone. Methods The eligible patients with gallbladder stones hospitalized in our department between January 2007 and December 2011 were included, and all of them received either laparoscopic cholecystolithotomy（observation group） or laparoscopic cholecystectomy（control group） minimally-invasive surgery. The operation time, bleeding volume, enterokinesia recovery time, hospital stay, post-operative complication and followup results were compared between the two groups. Results A total of 148 patients were included, with 68 patients in the observation group and 80 patients in the control group. In this cohort, the success rate of surgery for the observation group and the control group was 100.0%（68/68） and 98.8%（79/80）, respectively; and the success rate of complete stone removal was 100% for both two groups. B-ultrasound examination after 2 weeks of treatment showed that gallbladder wall was normal and gallbladder contraction rate was more than 30% for all patients with laparoscopic cholecystolithotomy. The operation time was（49.6 ± 5.2） minutes for the observation group and（50.5 ± 6.2） minutes for the control group, and bleeding volume was（9.5 ± 1.4） mL for the observation group and（50.2 ± 8.1） mL for the control group; the difference in bleeding volume was significant between the two groups（P〈0.05）. The difference in enterokinesia recovery time [（33.9 ± 2.2） and（34.4 ± 2.6） minutes] or hospital stay [（3.4 ± 1.0） and（3.6 ± 1.2） days] between the observation group and the control group was not significant（both P〈0.05）. The postoperative complications of bleeding, bile leakage and wound infection were not observed in both two groups, and all patients were followed up for 6 to 12 months with no stone recurrence; and only 2.7% of patients（1/37） had stone recurrence after 3-year followup. Conclusions Both laparoscopic cholecystolithotomy and laparoscopic cholecystectomy procedures are safe and efficient.However, laparoscopic cholecystolithotomy not only reserves gallbladder but also has superiority of less bleeding volume.