腹腔镜胆总管探查取石术两种术式的比较研究

目的对比研究腹腔镜经胆囊管探查取石术（LTCBDE）与腹腔镜胆总管切开取石并胆总管一期缝合术（LCPS）处理胆总管结石的疗效。方法回顾总结我院2003年2月至2006年1月64例经腹腔镜处理的胆总管结石患者的临床资料,其中LTCBDE组40例,LCPS组24例。比较观察两组的术中失血量、术后第5天丙氨酸氨基转移酶（ALT）值和总胆红素（TBIL）值、术后住院时间及住院费用。结果LTCBDE组较LCPS组术中失血量更少（P〈0.05）,术后住院时间和费用更少（P〈0.05）,两组术后第5天血清ALT和TBIL水平差异无统计学意义（P〉0.05）。64例患者均痊愈出院,无胆漏、出血等严重并发症,术后随访2-6个月,均未发现残余结石。结论LTCBDE和LCPS治疗胆总管结石均具有创伤小、恢复快、并发症少等优点,应根据具体情况选用两种术式。

The comparative study on two types of laparoscopic common bile duct exploration

Objective To investigate the clinical effect of LTCBDE vs LCPS in the treatment of the choledocholithiasis.Methods The clinical data of 64 cases of choledocholithiasis subject to laparoscopic treatment were retrospectively analyzed from Feb.2003 to Jan.2006,including 40 cases receiving LTCBDE and 24 cases receiving LCPS respectively.The perioperative blood loss,the serum levels of alanine aminotransferase(ALT) and total bilirubin(TBIL) at 5th day after operation,postoperative hospital stay and time of stay and cost of hospitalization were compared between two groups.Results In LTCBDE group,the perioperative blood loss and cost of hospitalization was less,and postoperative hospital stay was shorter significantly than in LCPS group(P<0.05).There was no significant difference in serum ALT and TBIL between the two groups(P>0.05).All patients were cured and no severe complications occurred.Conclusion There is no significant difference in the curative effectiveness between these two procedures in the treatment of the choledocholithiasis.Both are safe and feasible with less pain,less complication and quicker recovery.The optimal procedures should be selected according to the specific conditions.