腹腔镜保胆取石术治疗胆囊结石继发胆总管结石的临床研究

Clinical study of laparoscopic gallbladder-preserving cholelithotomy in the treatment of secondary choledocholithiasis caused by cholecystolithiasis

目的:探讨腹腔镜保胆取石术治疗胆囊结石继发胆总管结石的临床效果。方法:选取2007年1月至2015年9月58例胆囊结石合并胆总管结石的患者,分别行腹腔镜保胆取石术(保胆组)及腹腔镜胆总管切开取石T管引流术(T管组),对比分析两组患者术中出血量、手术时间、术后住院时间、术后腹腔引流时间、术后总并发症发生率。结果:两组患者术前临床资料差异无统计学意义,保胆组较T管组手术时间更短[(116±20)min vs.(162±17)min],术后总并发症发生率更低(0 vs.23.33%)。两组患者术中出血量[(119±22)ml vs.(117±24)ml]、术后腹腔引流时间[(3.30±0.80)d vs.(3.70±0.50)d]、术后住院时间[(5.5±1.5)d vs.(5.8±1.7)d]差异无统计学意义。结论:腹腔镜保胆取石术治疗胆囊结石继发胆总管结石相较腹腔镜胆总管切开取石+T管引流术具有操作简便、创伤小、康复快、术后并发症少等明显优势。

Objective： To investigate the clinical effect of laparoscopic gallbladder-preserving cholelithotomy in the treatment of secondary choledocholithiasis caused by cholecystolithiasis. Methods： From Jan. 2007 to Sep. 2015,58 patients with secondary choledocholithiasis caused by cholecystolithiasis in department of hepatobiliary surgery,Shaanxi Baoji People＇s Hospital were selected for analysis. The patients respectively underwent laparoscopic gallbladder-preserving cholelithotomy or laparoscopic choledocholithotomy T-tube drainage. The amount of bleeding,the operation time,the postoperative hospital stay,the postoperative abdominal drainage time,the incidence of postoperative total complications of the two groups were comparatively analyzed. Results： There were no significant differences in preoperative clinical data between the two groups. Compared with the T-tube group,laparoscopic cholelithotomy group had the shorter operation time [（ 116 ± 20） min vs.（ 162 ± 17） min] and the lower incidence of postoperative total complications（ 0 vs. 23. 33%）.There were no significant differences between two groups in the intraoperative blood loss [（ 119 ± 22） ml vs.（ 117 ± 24） ml],the postoperative abdominal drainage time [（ 3. 3 ± 0. 8） d vs.（ 3. 7 ± 0. 5） d]and the postoperative hospital stay [（ 5. 5 ± 1. 5） d vs.（ 5. 8 ±1. 7） d]. Conclusions： Compared with laparoscopic choledocholithotomy T-tube drainage,laparoscopic gallbladder-preserving cholelithotomy in the treatment of secondary choledocholithiasis caused by cholecystolithiasis has obvious advantages such as simpler operation,fewer trauma and complications,faster recovery and so on.