腹腔镜与开腹手术治疗TodaniⅠ型胆总管囊状扩张症的临床分析

目的:比较腹腔镜手术与开腹手术治疗TodaniⅠ型胆总管囊状扩张症的疗效.方法:收集2012年1月~2015年1月湖南省人民医院收治的41例胆总管囊状扩张症患者的病例资料,采用回顾性队列研究方法进行研究.按TodaniⅠ型胆总管囊状扩张症诊治原则进行腹腔镜手术18例,开腹手术23例.观察指标:(1)手术及恢复:手术时间、手术出血量、首次肛门排气时间、术后并发症、术后住院天数.(2)实验室检查:术前及术后第3天白细胞计数、C-反应蛋白、总胆红素、谷丙转氨酶、白蛋白数值.结果:(1)手术及恢复:腔镜组与开腹组手术时间无统计学差异;腔镜组与开腹组手术血量少于开放组;腔镜组与开腹组术后首次肛门排气时间腔镜组较短;腔镜组住院时长短于开腹组;术后并发症:总并发症发生率腔镜组22.2%,开腹组26.1%,并发症发生率无统计学差异.(2)实验室检查:腔镜组与开腹组的术前胆红素,白蛋白、谷丙转氨酶、白细胞计数、C-反应蛋白指标无统计学差异.两组患者术后的总胆红素、白蛋白、谷丙转氨酶无统计学差异;术后白细胞计数、C反应蛋白指标腔镜组较开腹组低.结论:腹腔镜治疗TodaniⅠ型胆总管囊状扩张症是安全有效的,且降低患者的手术创伤性应激和炎症反应,加快术后恢复,不增加并发症发生率.

Clinical efficacy of minimally invasive surgeries in the treatment of choledochal cyst

Objective To investigate the clinical efficacy of Laparoscopic surgeries and Laparotomy in the treatment of To-dani Ⅰ type choledochalcyst. Methods Theretrospective cohort study was conducted. Collect the clinical data of 41 patients with Todani type Ⅰ choledochal cyst who were admitted to the People's Hospital of Hunan Province from January 2012 to January 2015. Eighteen patients undergoing laparoscopic surgery were allocated into the Laparoscopic group and twenty-three patients undergoing Laparotomywere allocated into the Laparotomy group. The surgical procedure followed the treatment princi-ple of Todani Ⅰ type choledochal cyst completely in the two groups. Observation data included (1) surgical situation and Post-operative recovery: operation time, volume of blood loss in surgery, time of First anus exhaust, Postoperative complications, time of hospitalization. (2) Laboratory data: collect the data before surgery and third day after surgery including WBC、CRP、TBIL、ALT and ALB. The Ftest was used to analysis Count data, using the t test to analysis the data of cohort study in the two groups. Results (1) surgical situation and Postoperative recovery: Operation time in theLaparoscopic and Laparotomy groups, with no statistically significant difference. Volume of blood loss in surgerywere less in the Laparoscopic groups. Time of First anus ex-haust in the Laparoscopicwere shorter. The time of hospitalization in the laparoscopic wereshorter than the time in Laparotomy group. Postoperative complications: Overall incidence of complications in the Laparoscopic and Laparotomy groups were 22.2%and 26.1%, with no statistically significant. (2) Laboratory data: ① Before surgery: the data including WBC、CRP、TBIL、ALT and ALB in the Laparoscopic and Laparotomy groups with no statistically significant difference. After surgery: The data in the Laparoscopic and Laparotomy groups including Tbil、Alb and ALT with no statistically significant difference; Data of CRPand WBC in the Laparoscopicgroup were lower than the data in Laparotomy group. Conclusions Laparoscopic surgery are an effec-tive and safe treatment for Todani Ⅰ type choledochal cyst, it can reduce Surgical trauma and inflammation while not increasing postoperative complications.