腹腔镜与开腹再次胆道手术治疗胆总管结石的临床对比

Clinical comparison of laparoscopic and open reoperation in the treatment of common bile duct calculi with previous biliary tract surgery

目的比较腹腔镜与开腹再次胆道手术治疗胆总管结石的临床疗效。方法回顾性分析2014年7月至2016年2月收治的80例有胆道手术史的胆总管结石患者临床资料,根据手术方式将患者分为腹腔镜组(40例,行腹腔镜胆总管探查取石治疗)和开腹组(40例,行传统开腹胆总管探查取石治疗)。采用SPSS20.0软件进行统计学分析,手术相关指标等计量资料以(x珋±s)表示,采用独立t检验;术后恢复指标和术后并发症发生率等计数资料以例(%)表示,采用χ2检验,P<0.05为差异有统计学意义。结果腹腔镜组手术时间为(168.4±25.8)min,长于开腹组的(141.7±18.6)min,腹腔镜组术中出血量、胃肠功能恢复时间、术后住院时间分别为(151.3±36.6)ml、(1.8±0.9)d、(7.6±2.2)d,均显著少于开腹组的(244.7±48.5)ml、(3.1±1.7)d、(14.8±4.3)d,两组间的差异均有统计学意义(P<0.05);腹腔镜组术后镇痛率为32.5%,术后并发症发生率为5.0%,显著低于开腹组的65.0%和40.0%,差异均有统计学意义(P<0.05)。结论腹腔镜进行再次胆道手术治疗胆总管结石安全、可靠,创伤小、恢复快,值得临床推广应用。

Objective To compare the clinical effects of laparoscopic and open reoperation in the treatment of common bile duct calculi with previous biliary tract surgery. Methods 80 patients with previous history of biliary surgery for choledocholithiasis treated in our hospital from July 2014 to February 2016 were retrospectively analyzed. According to the different operation methods, they were divided into laparoscopic group （40 cases received laparoscopic surgery） and open group （40 cases received open surgery）. Statistical analysis was performed by using SPSS20. 0 software. The measurement data was expressed as （x -＋ s） and were compared by t test; Postoperative indexes and the rate of postoperative complication and other enumeration data were checked by chi square test. P 〈 0.05 was considered to be statistically significant. Results The operation time in the laparoscopic group was （ 168.4± 25.8 ） min, which was longer than that in the open group （ 141. 7 ± 18. 6） min. In the laparoscopic group, the intraoperative blood loss, the recovery time of gastrointestinal function and the length of hospitalization were （151.3 ±36.6） ml, （1.8±0.9） dand （7.6 ±2.2） d , which were lower than those in the open group （244.7± 48.5 ） ml, （3.1±1.7） d and （ 14.8± 4.3 ） d, the difference was statistically significant （ P 〈 0. 05 ）. The number of postoperative analgesia and the rate of postoperative complication in the laparoscopic group were 32.5% and 5.0% , which were lower than those in the open group 65.0% and 40.0% , the difference was statistically significant （P 〈 0. 05 ）. Conclusion The application of laparoscopic reoperation in the treatment of common bile duct calculi with previous biliary tract surgery is safe and effective, with the advantage of minor trauma and fast recovery, and it＇ s worthy of promotion.