腹腔镜与开腹手术在胆总管结石二次胆道手术中临床疗效对比

The comparison of laparoscopy and laparotomy in the secondary bile duct operation of patients with choledocholithiasis

目的比较腹腔镜取石术、开腹取石术在胆总管结石患者二次胆道手术中的临床疗效。方法选取在2014年2月至2017年5月期间收治的50例胆总管结石复发患者,根据随机数字表法随机分为腹腔镜组和开腹组各组25例。采用SPSS21.0统计学软件进行数据分析,术前术后计量资料以均数±标准差表示,采用独立t检验;术后24 h疼痛发生率和术后并发症用χ~2检验,P<0.05为差异具有统计学意义。结果术后,腹腔镜组手术出血量(P=0.004)、胃肠道功能恢复时间(P=0.021)、24 h疼痛发生率(P=0.021)、住院时间(P=0.007)均较开腹组显著降低;但腹腔镜组手术时间(P=0.028)、患者总费用(P=0.046)均显著高于开腹组;开腹组并发症发率明显高于腹腔镜组(36%比12%,P=0.037)。两组患者临床有效率均为100%。结论腹腔镜二次胆道手术与开腹取石术疗效相当,术后并发症发生率少,安全有效,值得临床推广。

Objective To explore the effect of Laparoscopic Lithotomy and Open Laparotomy in the secondary bile duct operation of patients with choledocholithiasis. Methods Fifty cases with recurrent choledocholithiasis treated in our hospital from February 2014 to May 2017 were analyzed. They were randomly divided into laparoscopic group and open group with 25 cases in each group. SPSS21. 0 statistical software was used for data analysis. Preoperative and postoperative measurement data were showed as（ ± s）deviation,compared with independent t test; Postoperative 24 h incidence of pain and postoperative complications were compared with χ~2 test,P 0. 05 indicated the difference was statistically significant.Results After surgery,The bleeding volume（ P = 0. 004）,gastrointestinal function recovery time（ P =0. 021）,24 h pain incidence（ P = 0. 021） and hospitalization time（ P = 0. 007） in laparoscopic group were significantly lower than those in laparotomy group. However,the operation time（ P = 0. 028） and the total cost of patients（ P = 0. 046） in laparoscopic group were significantly higher than those in laparotomy group.After surgery,the incidence of complications in the laparotomy group was significantly higher than that in the laparoscopy group（ 36% vs. 12%,P = 0. 037）. The clinical effective rate of the two groups was 100%.Conclusion The clinical efficacy of laparoscopic secondary biliary surgery and open secondary biliary surgery is similar,however,the incidence of postoperative complications of laparoscopic secondary biliary surgery is lower. Laparoscopic secondary biliary surgery is more safe and effective.