两种方法在治疗胆囊结石合并胆总管结石的研究

Study on two kinds of method for treating cholecystolithiasis complicated with choledocholithiasis

目的探讨比较腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石疗效。方法回顾性分析2011年1月至2013年12月该科收治的95例行手术治疗的胆囊结石合并胆总管结石患者临床资料,根据手术方式分为对照组(n=45)和观察组(n=50)。对照组行传统开腹手术,观察组行腹腔镜联合胆道镜手术。比较两组患者手术时间、术中出血量、术后肛门排气时间、住院时间等手术情况、术后并发症发生率及结石复发率。结果与对照组相比,观察组术中出血量明显减少,术后肛门排气时间及住院时间明显缩短,比较差异有统计学意义(P<0.05),而手术时间组间比较差异无统计学意义(P>0.05)。术后,观察组并发症发生率为6.0%,明显低于对照组20.0%的并发症发生率(P<0.05)。随访1年,观察组和对照组的结石复发率分别为2.0%和4.4%,组间比较差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜是治疗胆囊结石合并胆总管结石的有效手术方式,与传统开腹手术相比,术中出血量少、术后恢复快、术后并发症发生率低,值得临床进一步推广。

Objective To compare the curative efficacy of laparoscope combined with choledochoscope and traditional open surgery in the treatment of cholecystolithiasis complicated with choledocholithiasis .Methods The clinical data in 95 cases of cholecystolithiasis complicated with choledocholithiasis treated with surgery in our hospital from January 2011 to December 2013 were retrospectively analyzed .The patients were divided into the control group （n= 45） and the observation group（n= 50） according to the operation modes .The control group was given the traditional open surgery ,while the observation group was performed the laparoscopy combined with choledochoscopy operation .Then the operation time ,introperative bleeding volume ,postoperative anal exhausting time ,hospitalization time ,incidence of postoperative complications and calculi recurrence rate were compared between the two groups .Results Compared with the control group ,the intraoperative bleeding volume in the observation group was significantly decreased ,postoperative anal exhausting time and the hospitalization time were significantly shortened ,the differences were statistically significant （P〈 0 .05） ,while the peration time had no statistical difference between the two groups （P〉0 .05） .The incidence rate of postoperative complications in the observation group was 6 .0% ,which was significantly lower than 20 .0% in the control group（P〈 0 .05） .After the oneyear followup ,the calculi recurrence rate was 2 .0% in the observation group and 4 .4% in the control group ,showing no statistical difference between them（P＆gt;0 .05） .Conclusion Laparoscopy combined with choledochoscopy is an effective and safe operation mode for treating cholecystolithiasis complicated with choledocholithiasis ,in comparison with the traditional open surgery ,which has less bleed loss during surgery ,rapid postoperative recovery and lower incidence of postoperative complications ,and is worthy clinical further promotion .