腹腔镜在肝外胆道结石再手术中的应用价值

Value of laparoscopy in reoperation for extrahepatic bile duct stones

目的:比较腹腔镜与开腹手术在肝外胆管结石再手术治疗中的临床疗效.方法:将华北理工大学附属开滦总医院收治的244例胆道结石再手术患者依据术式随机划分为腹腔镜组121例和常规开腹手术组123例.比较两组患者手术情况、术后恢复情况及术后并发症情况.结果:腹腔镜组5例中转开腹,中转率4.13%,腹腔镜组患者平均手术时间显著长于开腹组(109.7 min±5.7min vs 97.8 min±7.7 min),术中平均出血量显著少于开腹组(32.7 m L±4.2 m L vs 92.7 m L±6.5 m L,P<0.05);腹腔镜组术后肛门排气时间,术后镇痛次数,术后住院时间,均显著低于开腹组(1.7 d±0.1 d vs3.0 d±0.6 d,1.4次±1.0次vs 2.9次±0.7次,8.5 d±0.9 d vs 12.0 d±1.2 d,P<0.05);腹腔镜组术后切口感染发生率显著低于开腹组(0%vs 4.88%,P<0.05).结论:腹腔镜在肝外胆管结石再手术治疗方面安全有效,并且创伤较小、术后并发症少,术后恢复快,在术者经验丰富的前提下应作为胆道结石再手术的首选手术方式.

AIM： To compare the clinical effects of laparoscopyvs open surgery in reoperation for extrahepatic bile duct stones. METHODS： Two hundred and forty-four patientswho underwent reoperation for extrahepatic bile duct stones were randomly divided into either a laparoscopy group （n = 121） or an open surgery group （n = 123）. Operative parameters, postoperative recovery, and complications were compared for the two groups. RESULTS： In the laparoscopy group, 116 cases had successful laparoscopic surgery, and 5 （4.13%） cases required conversion to open operation. Mean operative time for the laparoscopy group was significantly longer than that for the open surgery group （109.7 rain ± 5.7 rain vs 97.8 rain ± 7.7 rain, P 〈 0.05）. Mean bleeding Volume for the laparoscopy group was significantly less than that for the open surgery group （32.7 mL ±4.2 mL vs 92.7 mL ± 6.5 mIy, P 〈 0.05）. The time to anal exhaust, the number of times of analgesia usage, and length of stay for the laparoscopy group were significantly lower than those for the open surgery group （1.7 d ± 0.1 d vs 3.0 d ±0.6 d, 1.4 d ±1.0 d vs 2.9 d ± 0.7 d, 8.5 d± 0.9 d vs 12.0 d ±1.2 d, P 〈 0.05）. The rate of postoperative incision infection for the laparoscopy group was significantly lower than that for the open surgery group （0% vs 4.88%, P 〈 0.05）.CONCLUSION： Laparoscopic procedure has less surgical trauma, shorter postoperative recovery time, and fewer complications in patients with extrahepatic bile duct stones, and it is safe and feasible for experienced laparoscopic surgeons and should be the preferred method for those patients.