腹腔镜胆道探查术与传统开腹手术治疗胆囊结石并胆总管结石的疗效比较

Comparison of laparoscopic bile duct exploration with traditional laparotomy for cholecystolithiasis and choledocholithiasis

目的比较腹腔镜胆道探查术与传统开腹手术治疗胆囊结石并胆总管结石的疗效。方法选择武宣县人民医院普通外科于2015年1月至2017年1月期间收治的126例胆囊结石合并胆总管结石患者为研究对象,根据随机数表法分为观察组与对照组,每组63例。对照组患者予传统开腹手术治疗,观察组患者则予腹腔镜胆道探查术治疗,比较两组患者临床疗效及术后血清C反应蛋白(CRP)的动态变化。结果观察组患者术中出血量、术后肛门排气时间、住院时间分别为(42.6±10.4)m L、(1.9±0.4)d、(7.8±2.6)d,明显短于对照组的(78.9±20.5)m L、(2.8±1.1)d、(12.7±3.6)d,术后感染并发症发生率为1.59%,明显低于对照组的11.11%,差异均有统计学意义(P<0.05);观察组患者术后1 d、3 d、7 d时血清CRP水平分别为(21.0±4.4)mg/L、(15.1±4.3)mg/L、(7.1±2.2)mg/L,均明显低于对照组的(29.9±6.3)mg/L、(21.4±5.5)mg/L、(12.1±3.6)mg/L,差异均有统计学意义(P<0.05)。结论腹腔镜胆道探查术治疗胆囊结石合并胆总管结石具有微创的优势,应激反应轻,术后并发症发生率低、术后恢复快。

Objective To compare the efficacy of laparoscopic bile duct exploration and conventional laparotomy in the treatment of cholecystolithiasis and choledocholithiasis. Methods A total of 126 patients of cholecystolithiasis and choledocholithiasis treated in Department of General Surgery, Wuxuan People＇s Hospital from January 2015 to January 2017 were selected and divided into observation group and control group according to the random number table,with 63 patients in each group. The patients in the control group were treated by traditional laparotomy, while those in the observation group received laparoscopic bile duct exploration. The clinical efficacy and dynamic changes of serum C reactive protein（CRP） in the two groups were compared. Results The amount of bleeding, postoperative anal exhaust time, hospitalization time were（42.6±10.4） m L,（1.9±0.4） d,（7.8±2.6） d in the observation group, significantly less or shorter than（78.9±20.5） m L,（2.8±1.1） d,（12.7±3.6） d in the control group（P〈0.05）, and the incidence of postoperative infectious complications was 1.59% in the observation group versus 11.11% in the control group（P〈0.05）. The serum CRP level in the observation group at 1 day, 3 day and 7 day respectively was（21.0±4.4） mg/L,（15.1±4.3） mg/L,（7.1±2.2） mg/L, versus（29.9±6.3） mg/L,（21.4± 5.5） mg/L,（12.1±3.6） mg/L in the control group（P〈0.05）. Conclusion Laparoscopic bile duct exploration for cholecystolithiasis combined with choledocholithiasis has the advantages of minimal invasion, mild stress reaction, low postoperative complication rate, and rapid postoperative recovery.