胆总管结石患者微创术后腹腔感染因素与疗效分析

Risk factors of postoperative abdominal infections in choledocholithiasis patients with minimally invasive surgery and the curative effect

目的探讨微创胆总管取石手术在临床上的应用效果,分析导致胆总管结石患者微创手术后发生腹腔感染的相关因素与病原菌种类,为临床治疗提供参考依据。方法选取2013年4月-2015年3月在医院进行手术治疗的210例胆总管结石患者为研究对象,分为开腹组与微创组,每组各105例,开腹组患者采用开腹手术治疗,微创组患者采用微创手术治疗;比较两组患者临床资料,数据采用SPSS 18.0软件进行统计分析。结果微创组患者发生腹腔感染26例,导致感染的诸多因素中,胆漏比例最高占57.69%,其次是残余结石占23.08%,各种感染因素的比较差异有统计学意义(P<0.05);感染病原菌以革兰阴性菌为主占65.38%,其中大肠埃希菌占26.92%、粪肠球菌占19.23%;微创组患者手术失败5例,成功率为95.24%,出现并发症的有8例,结石残余与结石复发各有6例,其中手术失败、结石残余及结石复发差异有统计学意义(P<0.05);微创组患者手术时间、术后通气天数及住院时间明显短于开腹组,术中出血量也明显少于开腹组,且两组患者各临床疗效比较差异有统计学意义(P<0.05)。结论微创治疗胆总管结石疗效好,发生腹腔感染率低,是治疗胆总管结石较好的一种手术方法。

OBJECTIVE To explore the curative effect of minimally invasive surgery in treating choledocholithiasis and to analyze the risk factors causing abdominal infections after the surgery and the types of pathogenic bacteria so as to provide references for clinical treatments. METHODS Totally 210 cases of choledocholithiasis patients who received surgery from Apr. 2013 to Mar. 2015 were selected as study objects and they were divided into laparoto- my group and minimally invasive group with 105 cases each. The clinical data of the two groups were compared and SPSS 18.0 was adopted for statistical analysis. RESULTS Totally 26 cases in the minimally invasive group ap- peared abdominal infections and the leading factors included bile leakage, accounting for 57.69 %, followed by re- sidual stones, representing 23.08%, and the differences of various infectious factors were significant （P〈0.05）. The pathogenic bacteria were mainly gram-negative bacteria, accounting for 65.38%, including Escherichia coli （26.92%） and Enterococcus faecalis （19.23 %）. In the minimally invasive surgery group, 5 patients failed in the surgeries, and the success rate was 95.24%. Complications appeared in 8 patients, and 6 cases appeared retained stone and recurrence of calculus. The differences of surgery failure, retained stone and recurrence of calculus be- tween the two groups were significant （P〈0.05）. The operative time, postoperative ventilation days and hospital stay in the minimally invasive group were significantly shorter than the laparotomy group, and the blood loss was less too, and the differences between the two groups were significant （P〈0.05）. CONCLUSION Minimally inva- sire surgery has a great curative effect in treating choledocholithiasis with loW abdominal infections and is a better surgery method for curing choledocholithiasis compared with laparotomy.