腹腔镜治疗肝硬化伴胆总管结石的临床分析

Clinical analysis of laparoscopic treatment of common bile duct stones combined with hepatocirrhosis

目的探讨胆总管结石伴肝硬化患者行腹腔镜下胆总管取石探查术的可行性以及临床疗效。方法回顾性分析2013年6月至2016年6月收治的187例胆总管结石伴肝硬化患者的临床资料。患者分成腹腔镜下胆总管取石探查术(LCBDE,n=112)组和开腹胆总管取石探查术(OCBDE,n=75)组,应用SPSS 20.0统计学软件进行数据处理,计量资料(手术时间、术中失血量、血液学检查项目等)以均数±标准差或中位数(范围)表示,采用t检验和Mann-Whitney U检验;术后短期及长期并发症、结石复发率以构成比行χ2检验和Fisher精确概率法检验。以P<0.05为差异具有统计学意义。结果 LCBDE组术中出血量[100 ml(60~200 ml)]及术后住院时间(5.2±2.6)d都少于OCBDE组200(90~450),P<0.001)和(9.7±3.1)d,P<0.001,差异具有统计学意义。两组在手术时间、结石清除率、短期并发症、结石复发率上的差异均无统计学意义(P>0.05)。随访期间内,两组患者均未出现明显的胆总管损伤和狭窄。结论胆总管结石伴肝硬化患者(Child-Pugh A、B级)行腹腔镜下胆总管取石探查术是安全可行的;跟开腹手术相比,其具有术中出血少、术后住院时间短的优势。

Objective To investigate the feasibility and clinical efficacy of laparoscopic common bile duct exploration in patients with combined common bile duct stones and hepatocirrhosis. Methods the clinical data of 187 patients with common bile duct stones with liver cirrhosis treated in our hospital from June 2013 to - 2016 in June were analyzed retrospectively. All the patients were divided into laparoscopic common bile duct stone surgerygroup（LCBDE,n = 112） and laparotomy exploration of common bile duct stones group（OCBDE,n = 75）. Data were analyzed by using SPSS 20. 0 statistical software. Metrological data（operation time,intraoperative blood loss,hematological examination items,etc.） were expressed as mean ± standard deviation or median（range）,and were analyzed by using T test and Mann-Whitney U test.The postoperative short-term,long-term complications and the stone recurrence rate were compared by usingχ2test and Fisher exact probability test. A P value 0. 05 was considered as statistically significant difference. Results The blood loss in the LCBDE group and postoperative hospital stay（5. 2 ± 2. 6 vs.9. 7 ± 3. 1d） were less than OCBDE group,with statistically significant difference（P〈 0. 001）. There was no significant difference of operation time,stone clearance rate,short-term complications and recurrence rate between the two groups（P 〉0. 05）. During the follow-up period,there was no obvious common bile duct injury and stenosis occurred in both 2 groups. Conclusion Compared with open surgery,it is safe and feasible for patients with combined common bile duct stones and hepatocirrhosis（Child-Pugh A,B） to receive laparoscopic exploration of common bile duct calculi,with less blood loss and shorter hospital stay.