腹腔镜辅助下小切口治疗胆囊结石并胆总管结石的临床研究

Laparoscopic assisted small incision surgery for cholecystolithiasis and choledocholithiasis

目的比较开腹与腹腔镜胆囊切除＋辅助小切口胆总管探查取石术的临床效果。方法自2012年5月至2013年12月，68例胆囊结石合并胆总管结石适宜行腹腔镜胆囊切除小切口辅助胆总管探查的病人，男性25例，女性43例；年龄23~70岁，平均年龄47．3岁。随机将68例病人分别进入开腹胆囊切除＋胆总管探查取石术组（开腹组）与腹腔镜胆囊切除＋辅助小切口＋胆总管探查取石术组（小切口组）。其中，腹腔镜辅助下小切口胆总管探查36例，男性12例，女性24例，平均年龄49．6岁。病程3个月至22年。并比较两组相关临床指标。结果两组病例手术全部获得成功，腹腔镜辅助下小切口组无中转扩大手术切口，术后病人均恢复良好。温氏孔腹腔引流管均于术后2～3d无排液时拔除，两组术后4～5周行T管造影，均无胆道残石及狭窄，拔除T管。开腹组与腹腔镜辅助下小切口组比较，手术时间、术中出血、术后肠道功能恢复时间、术后镇痛剂的使用、伤口感染、住院时间，两组组间比较差异存在统计学意义（P〈0．01）；两组术后无胆瘘及胆道残石率发生。开腹组平均住院费用（8614．1±246．4）元，小切口组平均住院费用（7451．5±113．5）元，两组平均住院费用差异存在统计学意义（P〈0．05）。结论腹腔镜辅助下小切口行胆囊切除＋胆总管探查取石术，疗效满意、安全可行；比开腹手术更具有微创、并发症少、恢复快的优势。

Objective To compare the clinical efficacies of open cholecystectomy versus laparoscopic cholecystectomy, common bile duct exploration plus small incision. Methods A total of 68 patients with choleeystolithiasis and choledocholithiasis were divided into two groups of open choiecystectomy and common bile duet exploration （OC） and laparoscopic cholecystectomy and common bile duct exploration plus small incision group （SI）. And the relevant clinical parameters of two groups were compared. Results Neither postoperative biliary fistula nor residual stone was found. The values of operative duration, postoperative recovery and time of stay were significantly shorter in SI group than those in OC group. Significant differences existed in intraoperative blood loss, use of postoperative analgesics and wound infection （P〈0. 01）. Hospitalization costs were significantly reduced. Conclusions Laparoscopic eholecystectomy assisted small incision surgery and common bile duct exploration are both safe and feasible with satisfactory outcomes. Compared with open cholecystectomy, it offers the advantages of less invasiveness, fewer complications and faster recovery.