腹腔镜联合胆道镜保胆取石的临床疗效

Clinical outcome of combined laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy

目的探究腹腔镜联合胆道镜保胆取石医治胆囊结石的临床疗效。方法以2011年3月至2013年3月收治的胆囊结石行保胆取石治疗的80例患者为研究对象,根据患者及家属要求分为腹腔镜与胆道镜联合保胆取石组(观察组)和纤维胆道镜取石术组(对照组),各40例,利用SPSS19统计学软件进行对数据进行分析,两组患者术中及术后情况比较,采用t检验;术后并发症、清除率、复发率比较采用χ2检验,P<0.05被认为有统计学意义。结果平均出血量:观察组(15.63±3.72)ml少于对照组(41.35±4.68)ml;胃肠功能恢复时间:观察组(12.83±4.37)h早于对照组(26.31±5.73)h,差异均具有统计学意义(t=27.209、11.831,P<0.05);平均手术时间、术后平均住院时间,两组差异没有统计学意义(P>0.05)。观察组与对照组结石清除率分别为(95.0%比77.5%,χ2=5.165,P=0.023),术后并发症发生率分别为(2.5%比15.0%,χ2=3.914,P=0.048),术后2年复发率分别为(7.5%比25.0%,χ2=4.501,P=0.034),差异均具有统计学意义。术后2年所有患者FACT-G评分、术后胆囊壁厚度和胆囊收缩功能的变化都比术前改善明显(P<0.05)。结论将腹腔镜与胆道镜相联合来保胆取石医治胆囊结石具有很好的疗效,不仅保留了胆囊的完整性,还使患者生活质量得到明显提高,能够显著降低术后并发症的发生率,值得临床广泛应用。

Objective To evaluate the clinical outcome of combined laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy . Methods From March 2011 to March 2013, 80 patients with cholecystolithiasis , who received laparoscopic and/or choledochoscopic gallbladder-preserving cholelithotomy , were divided into laparoscopic and choledochoscopic gallbladder-preserving cholelithotomy group （observation group, n=40） and Fiber biliary endoscopy group （control group, n=40）.Data analysis was performed by using SPSS19 software, The intra-and post-operative data of patients were compared between the two groups by using t test .Postoperative complications , clearance rate and recurrence rate were compared by using χ^2 test.A P value 〈0.05 was considered as significant difference . Results Average blood loss of （15.63 ±3.72） ml in observation group was less than （41.35 ±4.68） ml in control group;Recovery time of gastrointestinal function of （12.83 ±4.37） h in observation group was less than （26.31 ± 5.73）h in control group,with significant differences （t =27.209 and 11.831 respectively, P 〈0.05）. There were no significant difference between 2 groups including mean operation time and average length of stay in hospital （P〉0.05）.Clearance rates of stone in observation group and control group were 95.0%and 77.5%respectively （χ^2 =5.165, P =0.023）.the postoperative complication rate was 2.5% and 15.0%respectively （χ^2 =3.914, P=0.048）.2 year-recurrence rate was 7.5% and 25.0% respectively （χ^2 =4.501, P=0.034） with significant differences.There were improvements in all of patients 2 years after surgery including FACT-G score, postoperative changes of the gallbladder wall thickness and contraction function of gallbladder （ P 〈0.05）. Conclusions The combined laparoscopic and choledochoscopic cholecystolithotomy cure gallstone could achieve satisfactory curative effect , not only to retain the integrity of the gallbladder but also to improve the quality of life of the patients and to reduce the incidence of＆amp;nbsp;postoperative complications .And it is worthy of wide application .