不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究

Prospective Clinical Study of Laparoscopic Common bile duct Exploration in Treatment of Choledocholithiasis in Different Ways

目的探讨对比经胆囊管腹腔镜胆道探查术与经胆总管切开T管引流手术治疗胆总管结石的临床效果。方法随机选取2013年7月—2014年6月该院收治的60例胆石症患者为研究对象,按照手术方法的不同将其分为观察组30例与对照组30例;给予观察组经胆囊管腹腔镜胆道探查术治疗,给予对照组经胆总管切开T管引流手术治疗。术后对比分析两组患者的手术时间、引流时间、术后排气时间、住院时间以及并发症发生情况等。结果观察组手术时间、引流时间、术后排气时间、住院时间均明显低于对照组;且两组比较差异有统计学意义(P<0.05)。观察组并发症总发生率为4.0%,对照组并发症总发生率为28.0%,同时观察组的胆漏、急性胰腺炎、急性胆汁腹膜炎、肝下积液感染、引流不畅等并发症的发生率显著小于对照组,两组比较差异有统计学意义(P<0.05)。结论使用胆囊管腹腔镜胆道探查术治疗胆总管结石症的效果优于胆总管切开T管引流手术,且该手术方法术后并发症发生率要低于胆总管切开T管引流手术,因此该方法值得临床推广应用。

Objective To compare the effect between laparoscopic common bile duct exploration via cystic duct and choledocholithotomy with T-tube drainage in the treatment of choledocholithiasis.Methods 60 patients with choledocholithiasis admitted to our hospital between July 2013- June 2014 were selected as the research objects and divided into observation group（n=30） and control group（n=30） according to the different method of operation.The observation group received laparoscopic common bile duct exploration via cystic duct,while the control was given choledocholithotomy with T-tube drainage.Surgery time,drainage time,postoperative exhaust time,length of hospital stay,and complications of the two groups were compared.Results The observation group operating time,drainage time,postoperative exhaust time,length of hospital stay were significantly lower than the control group;And the more similar between the two groups have statistical significance,P〈0.05.Observation group the total incidence of complications was 4.0%,control group total incidence of complications was 28.0%,the observation group at the same time of bile leakage,acute pancreatitis,acute biliary peritonitis,liver poor drainage of fluid from infection,the incidence of complications such as significantly less than the control group,two groups compare differences statistically significant,P〈0.05）.Conclusion In the treatment of choledocholithiasis,the effect of laparoscopic common bile duct exploration via cystic duct is better than that of choledocholithotomy with T-tube drainage which has higher of postoperative complications,so it is worthy of clinical popularization and application.