腹腔镜联合胆道镜保胆取石手术治疗合并肝硬化胆囊结石的疗效观察

Effect of preservation of gallbladder and removal of calculus by laparoscopy combined with choledochoscopy on cirrhosis cholecystolithiasis

目的探讨腹腔镜联合胆道镜保胆取石手术治疗合并肝硬化的胆囊结石患者的可行性与疗效。方法回顾性分析2008~2014年该院采用腹腔镜联合胆道镜保胆取石手术治疗的40例肝硬化胆囊结石患者为观察组,同期进行腹腔镜胆囊切除术的40例肝硬化胆囊结石患者为对照组,比较两组间手术中及手术后各项指标,并进行统计学分析。结果观察组患者术中出血量、手术时间、术后引流量、引流时间、肛门排气时间及住院时间均明显低于对照组患者,两组间比较差异有统计学意义(165.84 m L±50.23 m L vs 240.33 m L±150.56 m L,91.78 min±21.74 min vs 137.94 min±30.55 min,274.37 m L±121.15 m L vs 418.53 m L±132.24 m L,2.34 d±1.46 d vs 5.72 d±1.84 d,1.33 d±0.73 d vs 2.73 d±1.33 d,8.43 d±1.24 d vs 11.54 d±3.22 d,均P<0.05)。术后观察组患者出现感染、低蛋白血症的例数少于对照组患者,两组间比较差异有统计学意义[3(7.5%)vs 10(25.0%),4(10.0%)vs 12(30.0%),P<0.05];凝血功能障碍比较差异不明显[8(20.0%)vs 10(25.0%),P>0.05]。结论对符合条件的合并肝硬化的胆囊结石患者实施腹腔镜联合胆道镜保胆取石术具有安全性高、创伤小及康复快的优点,具有满意的疗效。

Objective To investigate the feasibility and efficacy of preservation of gallbladder and removal of calculus by laparoscopy combined with choledochoscopy on cirrhosis cholecystolithiasis. Methods Retrospective analysis from January 2008 to December 2014,80 patients with cholelithiasis and liver cirrhosis was carried out,the patients were divided into the observation group and the control group with 40 cases in each group. The observation group were treated with reservation of gallbladder and removal of calculus by laparoscopy combined with choledochoscopy,while the control group were treated with laparoscopic operation. The surgery and post-operative indicators were compared between the two groups. Results Intraoperative blood loss,operative time,ostoperative flow and drainage time,anal exhaust time and hospital stay in the observation group were significantly lower than those in the control group( 165. 84 m L ± 50. 23 m L vs 240. 33 m L ± 150. 56 m L,91. 78 min ± 21. 74 min vs 137. 94 min ± 30. 55 min,274. 37 m L ± 121. 15 m L vs 418. 53 m L ± 132. 24 m L,2. 34 d ± 1. 46 d vs 5. 72 d ± 1. 84 d,1. 33 d ± 0. 73 d vs 2. 73 d ± 1. 33 d,8. 43 d ± 1. 24 d vs 11. 54 d± 3. 22 d,P < 0. 05 for all). The percentages of patients developing infection and hypoalbuminemia were significantly lower in the observation group than in the control group( 7. 5% vs 25. 0%,10. 0% vs 30. 0%,P < 0. 05). The incidence of blood coagu-lation dysfunction did not differ significantly between the two groups( 20. 0% vs 25. 0%,P > 0. 05). Conclusion Preservation of gallbladder and removal of calculus by aparoscopy combined with choledochoscopy on cirrhosis cholecystolithiasis is a safe,minimally invasive,quick recovery with satisfactory results.