腹腔镜和开腹胆总管切开取石的病例配对研究

Case-matched Analysis of Laparoscopic Versus Open Choledocholithotomy

目的探讨腹腔镜胆总管切开取石术治疗胆总管结石的临床疗效。方法回顾性总结分析2016年6月至2017年6月在我科行腹腔镜胆总管切开取石术的30例病人资料,根据病人年龄、性别、术前是否存在黄疸为配对条件,在开腹胆总管切开取石术病例中进行1∶1配对抽取,共30例纳入开腹胆总管切开术组,对腹腔镜组和开腹组的病人进行病例配对研究临床效果。结果两组患者在性别、年龄、身体质量指数(BMI)、术前血红蛋白、术前总胆红素、术前白蛋白及术前胆总管直径的差异无统计学意义(P>0.05)。两组均无手术死亡病例出现,腹腔镜组无一例中转开腹。腹腔镜组术后下床活动时间、术后进食时间、切口感染病例及术后住院时间均少于开腹组,且术后镇痛药的使用率也明显低于开腹组,两组比较差异具有统计学意义(P<0.05);而两组手术时间、术中出血量、胆瘘发生率及住院费用方面相比较,差异无统计学意义(P>0.05)。结论腹腔镜胆总管切开取石术在获得与开腹手术同样的效果的同时还具有创伤小、恢复快等优点。

Objective To evaluate the clinical effect of the cases undergoing laparoscopic choledocholithotomy. Methods The consecutive patients undergone choledocholithotomy were selected in Department of general surgery from June 2016 to June 2017. 30 patients who accepted laparoscopie choledoeholithotomy were included in the analysis. Based on the age, gender and jaundice, we chose another 30 patients who underwent open choledocholithotomy as matched-pair group. The clinical effects of the open and laparoscopie approaches were compared and analyzed. Results There were no significant differences in gender, age, BMI, preoperative jaundice, preoperative liver function and preoperative hemoglobin. There were no deaths in both groups and no case in the laparoscopic choledocholithotomy group was converted to open operation during the operation. The postoperative ambulation time, time to start eating, the rate of incision infection and the postoperative hospital stay as well as the rate of analgesic usage for the laparoseopic eholedocholithotomy group were shorter than those of the open group, and there were significant differences between the two groups （ P 〈 0. 05 ）. However, the time of operation, the mean intraoperative blood loss, the incidence of biliary fistula and the total costs between the two groups were no statistical significance （ P 〉 0. 05 ）. Conclusion The laparoscopic eholedocholithotomy can obtain the same effect as laparotomy. And the former also has the advantages of smaller injury and faster postoperative recovery.