腹腔镜联合胆道镜与开腹行胆总管探查术治疗胆总管结石的疗效比较

目的探讨腹腔镜下联合胆道镜行胆总管探查术对比传统开腹胆总管探查术在治疗胆总管结石中的临床疗效。方法回顾性分析2013年6月至2015年6月120例胆总管结石并行胆总管探查取石术患者的临床资料,根据术式将患者分为腹腔镜胆总管探查术组(LCBDE)与开腹胆总管探查术组(OCBDE),每组各60例。手术均由同一组术者完成。采用SPSS 18.0软件进行统计学分析,术中术后各项指标等计量资料采用t检验,术后并发症计数资料采用χ2检验,P0.05被认为差异有统计学意义。结果 LCBDE组平均手术时间多于OCBDE组,但术中出血量[(44.8±11.7)ml比(69.1±17.5)ml]、术后止痛剂使用[(2.2±0.6)支比(3.5±0.7)支]、肛门排气时间[(23.6±5.3)h比(33.1±4.2)h]、平均住院时间[(6.9±1.0)d比(9.2±1.2)d]等均少于OCBDE组,差异均有统计学意义(P0.05);术后并发症两组差异无统计学意义(P0.05)。结论与传统开腹胆总管探查术相比,腹腔镜下联合胆道镜胆总管探查术治疗急性轻中度胆管炎、胆总管结石,具有手术创伤小、术后康复快、住院时间短、术后并发症少等优点,治疗效果确切,安全、可靠。有临床推广应用价值。

Clinical comparison of laparoscopic combined with cholangioscopic and open common bile duct exploration in treating common bile duct stones

Objective To compare the clinical outcome of patients with common bile duct stones,who received laparoscopic combined with choledochoscopic treatment or open surgery.Methods A retrospective analysis was performed in 120 patients with common bile duct stones in Wuhan General Hospital from June 2013 to June 2015,60 cases had received LCBDE(laparoseopie common bile duct exploration)and 60 cases undergone OCBDE(open common bile duct exploration).All patients were operated by one group of experienced surgeons.Data analysis were performed by using SPSS18.0 software.The measurement data such as perioperative indicators were examined by using t test and count data were examined by using x2 test.A P value <0.05 was considered as statistically significant difference.Results All procedures were completed successfully.Compared with OCBDE group,there were more operation time,less blood loss(44.8±11.7)ml vs.(69.1±17.5)ml(P<0.01)in LCBDE group.Furthermore,LCBDE group compared with OCBDE group,such as dosage of pain killers(2.2±0.6)vs.(3.5±0.7),the time of the first flatus(23.6±5.3)vs.(33.1±4.2)h,the length of time in hospital(6.9±1.0)d vs.(9.2±1.2)d,the LCBDE group was significantly shorter or less respectively(P<0.01).There were no statistically significant difference of complication rate between two group,including postoperative biliary fistular and abdominal abscess(P>0.05).Conclusion It showed satisfactory curative effect in treatment of eholedoeholithiasis by laparoscope combined with choledochoscope.Compared to traditional surgery,LCBDE showed minimal invasion,and faster recovery.It is a safe and feasible method,and worth of clinical promotion.