上腹部术后行腹腔镜胆总管探查术的安全性分析

Safety Analysis of Laparoscopic Common Bile Duct Exploration After Upper Abdominal Surgery

目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)治疗有上腹部手术史的胆总管结石患者的安全性及可行性。方法收集宁夏回族自治区人民医院2011年11月至2017年6月有上腹部手术史的胆总管结石患者病例资料共75例,根据手术方式分为LCBDE组(观察组)25例,开腹胆总管探查术(open common bile duct exploration,OCBDE)组(对照组)50例,分析两组患者手术时间、术中出血量、术后黄疸恢复时间、术后镇痛例数、术后住院时间及术后近期并发症发生情况、结石残余率等。结果两组患者在手术时间、术后黄疸恢复时间、术后近期并发症之间比较差异均无统计学意义(P均>0.05)。观察组术中出血量[(60.40±33.72)mL]少于对照组[(126.60±137.54)mL](t=2.364,P<0.05);观察组和对照组术后住院时间分别为(7.12±1.88)、(13.58±8.94)d,术后进食时间分别为(2.00±1.23)、(4.58±3.83)d,观察组均短于对照组(t=3.562、3.277,P均<0.05);观察组和对照组术后镇痛比例分别为12.0%、34%,观察组低于对照组(χ^(2)=4.125,P<0.05)。结论腹腔镜探查取石在治疗胆总管结石合并有上腹部手术史的患者安全有效、切实可行,具有创伤小、恢复快等优点,值得推广。

Objective To explore the safety and feasibility of laparoscopic common bile duct exploration(LCBDE)to treat patients with biliary tube stones with a history of upper abdominal surgery.Methods A total of 75 cases of bile duct stone patients with a history of upper abdominal surgery from November 2011 to June 2017 were collected,25 cases were divided into LCBDE group(observation group)according to surgical methods,50 cases of open common bile duct exploration(OCBDE)(control group).The surgery time of the two groups of patients,intraoperative bleeding volume,postoperative jaundice recovery time,postoperative analgesia,postoperative hospitalization time and recent complications after surgery,stone residue rate,etc were compared and analyzed.Results There was no significant statistical difference between the surgery time,postoperative jaundice recovery time,and recent complications after surgery(P all>0.05).The amount of bleeding in the observation group(60.40±33.72)mL was significantly less than that of the control group(126.60±137.54)mL(t=2.364,P<0.05);The postoperative hospital stay of the observation group and the control group were(7.12±1.88)d and(13.58±8.94)d,and the postoperative eating time were(2.00±1.23)d and(4.58±3.83)d,The observation group was significantly shorter than In the control group,the comparison between the two groups was statistically significant(t=3.562,3.277,P all<0.05);The rate of postoperative analgesia in the observation group and the control group was 12.0%(3/25)and 34%(17/50),respectively.The observation group was significantly lower than the control group(χ^(2)=4.125,P<0.05).Conclusion Laparoscopic detection stone in the treatment of bile duct stones combined on the abdominal surgery history of patients is safe and effective,practical,with small trauma,quick recovery and other advantages,worthy of promotion.