腹腔镜下二次胆道探查的临床疗效

A Study of Reoperation of Laparoscopic Bile Duct Exploration in Cholangiolithiasis

目的分析腹腔镜下二次胆道探查与传统开腹二次胆道探查的临床疗效.方法前瞻性研究昆明医科大学第一附属医院2016年1月至2017年12月46例行二次胆道探查的患者,腹腔镜组23例,常规开腹组23例.比较两组患者的手术时间、术中失血量、术后患者的疼痛评分,通气时间、住院时间和术后并发症的发生.结果 2组患者顺利完成手术,腹腔镜组与常规开腹组比较,手术时间方面差异无统计学意义[(127.4±27.9)min vs (131.7±22.2)min,t=-0.709,P=0.482],但术后疼痛评分[(2.3±0.8) vs (3.1±0.7),t=3.681,P<0.001]、通气时间[(1.5±0.7)d vs (3.3±0.7)d,t=9.406,P<0.001]、住院时间[(5.1±0.9)d vs (8.6±1.2)d,t=11.360,P<0.001]方面有明显的统计学差异.随访3月,患者术后恢复良好,经T管造影检查未发现结石.结论腹腔镜下二次胆道探查安全,有效,能减轻患者术后的疼痛,缩短术后通气时间,减少住院天数,值得临床推广应用.

Objective To analyze the clinical treatment effect of laparoscopicbile duct exploration andlaparotomy in the treatment ofcholangiolithiasis. Methods Between January 2016 and December 2017, a total of 46 patients with cholangiolithiasis were registered prospectively. They were selected and randomly divided into the laparoscopic group and the laparotomy group, 23 cases in each group. Theoperation time,intraoperative bloodloss, the postoperative pain scores, postoperative ventilation time, length of stay and postoperative complications between the two groups were compared. Result All patients were successfully operated. There were no statistical differences in operation time [（ 127. 4 ± 27. 9） min vs（ 131. 7 ± 22. 2） min, t=-0. 709, P = 0. 482 ]. The laparoscopic group had lesss cores of pain [（ 2. 3 ± 0. 8） vs（ 3. 1 ± 0. 7）, t =3. 681,P〈0. 001 ], shorter time of postoperative ventilation [（ 1. 5 ± 0. 7） d vs（ 3. 3 ± 0. 7） d, t =9. 406, P〈0. 001 ],shorter postoperative hospitalization days [（ 5. 1 ± 0. 9） d vs（ 8. 6 ± 1. 2） d, t =11. 360, P〈0. 001 ]. 3 monthsfollow-up, All patient recovered well and no stones were found by T-tube angiography. Conclusion Reoperation of laparoscopic bile duct exploration in cholangiolithiasis is safe and effective. It has the advantages of less pain scores, shorter postoperative ventilation time and hospitalization days. Patients could benefit from the operation.