腹腔镜胆道镜下保胆取石术治疗胆囊结石54例

Laparoscopic choledocholithotomy for gallbladder stone treatment: a report of 54 cases

目的观察腹腔镜胆道镜下保胆取石术对胆囊结石患者手术时长、肠蠕动恢复及术后复发率的影响。方法选择2015年6月至2016年11月收治的108例胆囊结石患者为研究对象,按随机数字表法分为对照组和观察组各54例。对照组给予腹腔镜胆囊切除术治疗,观察组给予腹腔镜胆道镜下保胆取石术治疗;比较两组手术时长、肠蠕动恢复时间及术后复发率。结果与对照组相比,观察组手术切口长度[(1. 06±0. 17) cm vs(2. 55±0. 42)cm]、术中出血量[(8. 72±1. 36) ml vs(14. 35±2. 28) ml]、住院时间[(3. 64±0. 53) d vs(4. 78±0. 76) d]均降低,而手术时长升高[(41. 82±6. 85) min vs(33. 57±5. 49) min],差异具有统计学意义(P <0. 01);与对照组相比,观察组肠蠕动恢复时间[(30. 65±5. 12) h vs(35. 28±5. 74) h]、肠鸣音恢复时间[(10. 65±1. 74) h vs(14. 37±2. 36) h]、首次排气时间[(18. 25±3. 13) h vs(23. 86±4. 09) h]、首次排便时间[(21. 42±3. 56) h vs(24. 78±4. 13) h]及疼痛视觉评分量表(VAS)评分均降低,而生活质量评价量表(SF-36)评分升高,差异具有统计学意义(P <0. 01);两组并发症发生率、结石复发率比较差异无统计学意义(P> 0. 05)。结论采用腹腔镜胆道镜下保胆取石术治疗胆囊结石患者,可显著改善手术相关症状,并促进肠道恢复,安全性好。

Objective To investigate the influence of laparoscopic choledocholithotomy on operation time,peristalsis recovery and recurrence rate in patients with gallstone. Methods A total of 108 patients with gallstone who received treatment from June 2015 to November 2016 were selected and divided into control group and observation group according to random number table（n = 54,each）. Control group patients received laparoscopic cholecystectomy and observation group patients received laparoscopic choledocholithotomy. The operation time,time of peristalsis recovery and recurrence rate were compared between two groups. Results Compared with control group,observation group had shorter incision length[（1. 06 ± 0. 17） cm vs（2. 55 ± 0. 42） cm],fewer intra-operative bleeding [（8. 72 ± 1. 36） ml vs（14. 35 ± 2. 28） ml],shorter hospital stay [（3. 64 ± 0. 53） d vs（4. 78 ± 0. 76） d] and longer operation time[（41. 82 ± 6. 85） min vs（33. 57 ±5. 49） min]（all P〈0. 01）. The peristalsis recovery time [（30. 65 ± 5. 12） h vs（35. 28 ± 5. 74） h],bowel sound recovery time [（10. 65 ± 1. 74） h vs（14. 37 ± 2. 36） h ],first exhaust time [（18. 25 ± 3. 13） h vs（23. 86 ± 4. 09） h ],first defecations time[（21. 42 ± 3. 56） h vs（24. 78 ± 4. 13） h] were shorter,visual analogue scale was lower and the score of short form（36） health survey was higher significantly in observation group（all P〈0. 01）. There were no significant difference in complication rate and gallstone recurrence rate between two groups（all P〈0. 05）. Conclusion In the treatment of gallstone,laparoscopic choledocholithotomy could significantly improve operation related symptoms and promote intestinal recovery with a good safety.