微创保胆取石术与腹腔镜胆囊切除术治疗胆囊多发结石的临床对比研究

Clinical comparative study of laparoscopic gallbladder-preserved cholecystolithotomy and cholecystectomy

目的分析比较胆囊多发结石微创保胆取石术与腹腔镜胆囊切除术两种手术方式的临床治疗效果。方法选取2011年6月至2014年6月期间于我院肝胆外科接受手术治疗的427例胆囊结石患者作为研究对象,根据手术方式不同分为微创保胆取石组(GPC组)和腹腔镜胆囊切除组(LC组),对两组患者的年龄、性别、手术情况、术后并发症情况、术后生存质量及结石复发等进行对比分析。结果两组患者的性别、年龄差异无统计学意义(P>0.05);LC组患者术中胆管损伤、术后胆瘘、腹腔内出血的发生率高于GPC组,但差异无统计学意义(P>0.05);GPC组患者的平均手术时间和住院时间长于LC组,且差异具有统计学意义(P<0.05);两种治疗手段均可有效缓解患者腹痛症状,但LC组患者术后易出现轻度腹泻症状,差异具有统计学意义(P<0.05),GPC组患者术后有1例复发病例,差异无统计学意义(P>0.05)。结论在严格把控手术适应症的情况下,实施腹腔镜联合胆道镜保胆取石术对于保留胆囊的正常生理功能,提高患者术后的生存质量具有重要意义,是一种安全、有效的胆囊结石治疗新手段。

Objective To analysis and compare the clinical treatment effect of two surgical methods of gallbladder-preserved cholecystolithotomy（GPC）and laparoscope cholecystectomy（LC）.Methods We choose 427 case of patients with gallbladder stone who were treated in our department of hepatobiliary surgery from 2011 June to 2014 June.According to different surgical method,they were divided into the group of GPC（62cases）and the group of LC（365cases）.Then we compared and analyzed patients＇ age,gender,operation condition,postoperative complications,postoperative survival and the recurrence of gallstone of two groups.Results The difference in patients＇ age and gender of two groups was not statistically significant（P〈0.05）.Patients＇ incidence of bile duct injury,postoperative bile leakage,and intra abdominal hemorrhage in the LC group were higher than those of GPC group,but the difference was not statistically significant.While patients＇ average operation time and hospitalization time of the GPC group were longer than those of the LC group,and the difference was statistically significant（P〈0.05）.The two kind of treatment effectively alleviated the symptoms of abdominal pain,but the patient in the LC group would occur mild diarrhea,the difference was statistically significant（P〈0.05）.One patient got stone recurrence in the GPC group,the difference was not statistically significant（P〈0.05）.Conclusion Gallbladder-preserved cholecystolithotomy could preserve the gallbladder＇s normal physiological function in strict control of surgical indications,meanwhile it could also significantly improve patients＇ quality of the life.It is a safe and effective new means of gallstone treatment.