腹腔镜联合胆道镜和传统开腹取石术治疗胆石症的优劣差异

Difference of laparoscopy combined with choledochoscopy and traditional laparotomy for cholelithiasis

目的通过观察胆石症患者应用不同手术方式治疗后的临床疗效,探究对比腹腔镜联合胆道镜和传统开腹取石术治疗胆石症的优劣差异。方法选取2014年10月~2016年11月在我院接受治疗的胆石症患者98例,分为观察组和治疗组,两组患者均为49例,其中观察组患者采用的治疗方案为腹腔镜联合胆道镜手术,对照组患者采用的治疗方案为传统开腹取石术,观察记录两组患者的相关临床数据并进行对比分析,包括切口长度、手术时间、术中出血量、术后出血、术后疼痛情况(疼痛的程度、持续时间)、术后首次下床时间、胃肠功能恢复时间(肠鸣音恢复、肛门排气、首次排便时间)、住院时间、术后并发症发生率及结石残留率等指标。结果两组患者的手术时间、术后胆瘘差异均无统计学意义(P>0.05);观察组切口长度、术中出血量、术后疼痛情况、胃肠功能恢复时间、术后出血、住院时间、并发症发生率及结石残留率均优于对照组,差异均有统计学意义(P<0.05)。结论相比于开腹取石术,运用腹腔镜联合胆道镜治疗胆石症时可以取得更为显著的效果,具有安全性高、并发症和结石残留率低等优势,患者疼痛程度轻,疼痛持续时间和胃肠道功能恢复时间均较开腹取石术明显缩短,因而腹腔镜联合胆道镜治疗胆石症可在临床上进行推广应用。

Objective By observing the clincial efficacy of different surgical treatment for cholelithiasis, to explore the advantages and disadvantages of laparoscopy combined with choledochoscopy and traditional open lithotomy in the treatment of cholelithiasis. Methods 98 patients with cholelithiasis cured in our hospital from October 2014 to November 2016 were selected and divided into observation group and treatment group with 49 cases in each. Patients in observation group were treated with laparoscopy combined with choledochoscopy, and patients in control group were treated with traditional open lithotomy. The clinical data of two groups were recorded and compared, the clinical data included incision length, operative time, intraoperative bleeding volume, postoperative bleeding, postoperative pain （pain, duration）, the first postoperative bed time, gastrointestinal function recovery time （bowel sounds recovery, anal exhaust and defecation）, hospitalization time, postoperative complications and incidence of residual stones rate index and others. Results There was no significant difference in the operation time and biliary fistula between the two groups （P 〉 0.05）. The incision length, intraoperative bleeding volume, postoperative pain, gastrointestinal function recovery time, postoperative bleeding, time, complication rate and the rate of residual stones in observation group were better than those in control group, the differences were statistically significant （P ~ 0.05）. Conclusion Compared with open cholecystectomy, laparoscopic surgery combined with choledochoscopy for cholelithiasis can achieve more significant results. It has the advantages of high safety, low complications and low residual stones rate. The patient has mild pain. The duration of pain and the recovery time of gastrointestinal function are significantly shorter than those of laparotomy. Therefore, laparoscopy combined with choledochoscopy in the treatment of cholelithiasis can be popularized in clinical practice.