腹腔镜经胆囊管探查取石的效果研究

Clinical study of stone removal through cholecystic duct by laparoscopic exploration

目的探讨腹腔镜经胆囊管探查取石术和腹腔镜胆总管切开取石术的手术效果及术后恢复情况。方法回顾性分析肝胆外科2014年1月至2017年7月胆囊结石合并胆总管结石患者100例的临床资料。其中行腹腔镜胆囊管探查取石(胆囊管组)55例,行腹腔镜胆总管切开取石、T管引流(胆总管组)45例。结果2组患者手术时间、术中出血、术后首次排气时间、术后止痛药物时间、腹腔引流管留置时间、术后胃管拔除时间、术后并发症、术后住院时间、住院费用相比,差异均有统计学意义(P<0.05);而术后留置尿管时间、术后3 d丙氨酸氨基转移酶、术后3 d天冬氨酸氨基转移酶、术后3 d总胆红素差异无统计学意义(P>0.05)。结论腹腔镜经胆囊管探查取石术的手术效果及术后恢复情况优于腹腔镜胆总管切开取石、T管引流,是一种有效、安全的治疗方法。

Objective To investigate the operation effects and postoperative recovery status by laparoscopic cholecystolithotomy and laparoscopic choledocholithotomy.Methods The clinical data about 100 patients with cholecystolithiasis complicated by choledocholithiasis who were treated in our hospital from January 2014 to July 2017 were retrospectively analyzed,of whom,55 patients underwent laparoscopic transcystic cholecystic duct exploration(cholecystic duct group),and 45 patients underwent laparoscopic common bile duct exploration with T tube drainage(common bile duct group).Results There were significant differences in operation time,intraoperative bleeding,postoperative first exhaust time,postoperative analgesic time,postoperative indwelling time of abdominal drainage tube,postoperative gastric tube removal time,postoperative complications,postoperative hospitalization time and hospitalization expenses between the two groups(P<0.05),however,there were no significant differences in postoperative urethral indwelling time,and the levels of alanine aminotransferase,aspartic aminotransferase,total bilirubin at three days after operation between the two groups(P>0.05).Conclusion The surgical effects and postoperative recovery after laparoscopic transcystic cholecystic duct exploration are superior to those by laparoscopic common bile duct exploration with T tube drainage,the former is an effective and safe treatment method for patients with cholecystolithiasis complicated by choledocholithiasis.