腹腔镜与开腹手术治疗结石性胆囊炎的临床对照研究

Comparative study of laparoscopic and open cholecystectomy in calculous cholecystitis

目的比较腹腔镜胆囊切除术(LC)与传统开腹胆囊切除术(OC)治疗结石性胆囊炎的疗效。方法选择150例结石性胆囊炎患者,其中男性53例,女性97例,年龄26~76岁,平均年龄51岁。其中100例行LC治疗(LC组),50例采用传统OC治疗(OC组)。比较两组手术时间、术中出血量、疼痛评分[视觉模拟疼痛量表(VAS)评分]、下床活动时间、胃肠功能恢复时间、住院时间、手术并发症等指标。结果手术时间LC组短于OC组[(40.50±6.21)min vs(62.35±13.52)min];术中出血量LC组少于OC组[(15.84±10.65)m L vs(68.86±15.61)m L];疼痛VAS评分LC组低于OC组[(2.26±1.10)分vs(6.03±1.83)分];下床活动时间LC组少于OC组[(13.58±6.65)h vs(24.27±10.36)h];LC组胃肠功能恢复时间[(10.05±4.96)h vs(30.86±7.33)h]及住院时间[(4.56±1.39)d vs(7.56±2.29)d]均小于OC组;差异均具有统计学意义(P<0.05)。LC组胆管损伤1例,并发症发生率1%。OC组切口感染、肠粘连、胆管损伤及腹腔感染分别为1例、2例、2例、1例,并发症发生率12%。3例(两组)胆管损伤的部位均为胆囊,原因为部分胆囊水肿明显,胆囊壁张力过大,以致于手术时损伤胆囊。结论 LC治疗结石性胆囊炎具有微创、安全、有效等优点,值得临床推广应用。

Objective To compare the efficacy of laparoscopic cholecystectomy（LC） and traditional open cholecystectomy（OC） in the treatment of calculous cholecystitis. Methods A total of 150 patients with calculous cholecystitis were enrolled, which included 53 males and 97 females, aged 26-76 years old with mean age of 51-year-old. A total of 100 cases were treated with LC（LC group） and 50 were treated with traditional OC（OC group）. The clinical data of operative time, intraoperative blood loss,pain score [visual analogue scale（VAS） score], off-bed time, gastrointestinal function recovery time, hospitalization time and complications between 2 groups were compared. Results Compared with LC group and OC group, the operative time[（40.50 ±6.21） minutes vs（62.35 ± 13.52） minutes], intraoperative blood loss[（15.84 ± 10.65） m L vs（68.86 ± 15.61） m L], VAS score[（2.26 ±1.10） vs（6.03 ± 1.83）], off-bed time[（13.58 ± 6.65） hours vs（24.27 ± 10.36） hours], gastrointestinal function recovery time[（10.05 ±4.96） hours vs（30.86 ± 7.33） hours], hospitalization time[（4.56 ± 1.39） days vs（7.56 ± 2.29） days] were lower, the difference was statistically significant（P〈0.05）. The 1 case of bile duct injury occurred in LC group, and the incidence of complications was1 %. In OC group, the incision infection was 1 case, intestinal adhesion of 2, bile duct injury of 2, intraabdominal infection of 1, and incidence of complications was 12 %. Three cases of bile duct injury were in gallbladder because of obvious gallbladder edema and large tension in gallbladder wall. Conclusion It is demonstrated that in the treatment of calculous cholecystitis, LC shows some advantages, such as minimally invasive, safety and effective, which is worth of clinical application.