三种术式治疗胆囊结石合并胆总管结石的临床效果比较

Comparison and clinical analysis of three kinds of surgical treatment for cholecysto-choledocholithiasis

目的比较传统开腹法、腹腔镜联合胆道镜(LC+LCBDE)及腹腔镜联合逆行胆道造影(LC+ERCP)三种术式治疗胆囊结石合并胆总管结石的临床效果及安全性分析。方法回顾性分析2015年2月至2016年12月150例胆囊结石合并胆总管结石的患者资料,根据术式不同分为三组:A组(开腹组)、B组(LC+LCBDE)和C组(LC+ERCP/EST),每组各50例。数据分析利用SPSS20.0统计学软件进行,患者一般资料、术中术后各项计量指标用(x珋±s)表示,数据采用F检验;术后并发症发生率采用卡方检验,P<0.05差异有统计学意义。结果同A组相比,B组和C组的术后排气时间、术后进食时间和住院时间显著减少(P<0.05);手术时间A组最短,B组与C组相当,三组差异具统计学意义(P<0.05);A组术中出血量最高,B组和C组出血量相当(P<0.05);术后近期并发症发生率A、B、C三组分别为16.0%比4.0%比4.0%(P<0.05),手术成功率三组分别为68%、96%和94%,差异均有统计学意义(P<0.05);C组术后血淀粉酶明显升高达24.0%(P<0.05);住院费用C组最高为(32723.5±1564.8)元,组间差异均有统计学意义(P<0.05)。结论 LC+LCBDE术式在手术治愈率及预后恢复上临床效果更优,临床上应优先考虑该种方案,但应结合实际诊治条件个性化选择具体操作术式。

Objective To analyze the clinical effects of three kinds of surgical treatment for cholecysto-choledocholithiasis. Methods A total of 150 patients with cholecysto-choledocholithiasis treated in our hospital from February 2015 to December 2016 were collected and divided into three groups . Group A（traditional operation）,group B（LC ＋LCBDE） and group C（LC ＋ERCP/EST）,each 50 cases. The clinical data were collected and compared in three groups .SPSS20.0 statistical software were used for statistical analysis, The measurement datawere shown as （ -x ±s）, F test was used in the group comparison ,χ2 test was used in the incidence of complication , and P 〈0.05 was regarded as statistically significant . Results Group A showed the longest postoperative exhaust time , postoperative time of food intake and hospital stays （P 〈0.05）.Group B and group C showed longer operation time （P 〈0.05）.The amount of intraoperative blood loss was highest in group A , while relatively the same in group B and group C （P 〈0.05）.The success rate in three group was 68%, 96%, 94% respectively （P 〈0.05）.Postoperative complication rate in three group was16.0% vs 4.0% vs 4.0%.The level of blood amylase was highest in group C （24.0%, P 〈0.05）, and also the hospitalization expenses （32723.5 ±1564.8） yuan in group C was the most expensive. Conclusions LC ＋LCBDE operation method shows better clinical effects , and should be first considered in clinical treatment for cholecysto -choledocholithiasis.Meanwhile, specific operation method needs to be selected to meet the needs of individual treatment .