腹腔镜联合胆道镜保胆取石术和腹腔镜胆囊切除术治疗胆囊结石的疗效对比

目的 比较腹腔镜联合胆道镜保胆取石术以及腹腔镜胆囊切除术两种诊疗方案在胆囊结石治疗上的相关疗效。 方法 回顾分析芜湖市第二人民医院2014年1月-2016年1月80例胆囊结石患者临床资料,按手术方式的不同将患者分为保胆取石组(37例)和胆囊切除组(43例),对2组患者的总成功率、并发症发生率、住院总时间、术后住院时间、术中出血量、留置引流管例数、术后通气时间、术后并发症例数、术后24 h疼痛程度、术后结石复发、术后胆囊收缩功能等相关临床数据进行统计学分析。 结果 2组患者的总成功率、并发症发生率、住院总时间、术后住院时间、术中出血量差异均无统计学意义(P>0.05);保胆取石组留置引流管例数明显多于胆囊切除组,而保胆取石组的术后通气时间、术后并发症例数、术后24 h疼痛程度小于胆囊切除组,差异具有统计学意义(P<0.05)。保胆取石组术后随访未发现胆囊结石复发,术后6个月、术后1年胆囊收缩功能较术前改善(P<0.05)。胆囊切除组术后随访未发现胆管结石。 结论 腹腔镜联合胆道镜保胆取石术和腹腔镜胆囊切除术治疗胆囊结石效果明确,安全可行。腹腔镜联合胆道镜保胆取石术保留了有功能的胆囊,患者生活质量提高,是除腹腔镜胆囊切除术外另一有效的手术方式,对于胆囊结石患者应根据患者的胆囊和全身状况以及本人意愿综合考虑选择合适的治疗方式,从而实现胆囊结石治疗的个体化。 

A comparative study of curative effect between cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope and laparoscopic cholecystectomy in patients with cholecystolithiasis

Objective To compare the therapeutic effectiveness between cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope and laparoscopic cholecystectomy in the treatment of cholecystolithiasis. Methods The clinical data of 80 cases of cholecystolithiasis in our hospital between January,2014 and January,2016 were analyzed retrospectively.Thirty-seven patients in the gallbladder-preserving surgery (GPS) group received cholecystolithotomy with gallbladder reservation by laparoscopy and choledochoscope,while 43 patients in the laparoscopic cholecystectomy (LC) group underwent laparoscopic cholecystectomy surgery.The difference between the two groups in the total successful rate,incidence of complication,total and postoperative hospitalization time,perioperative bleeding,cases with postoperative drainage,time to first flatus passage,cases with postoperative complication,postoperative pain intensity within 24 hours,recurrence rate of cholecystolithiasis,and gallbladder shrinking functions were compared. Results There were no statistically significance in total successful rate,incidence of complication,total and postoperative hospitalization time and perioperative bleeding between two groups (P>0.05),but the postoperative drainage cases in GPS group was significant more than that in LC group,while the time to first flatus passage,cases with postoperative complication,postoperative pain intensity within 24 hours in GPS group were significant less than those in the LC group (P<0.05).The follow-up showed that there was no recurrent choledocholithiasis in both groups,and the gallbladder shrinking functions at 6 months and 1 year after the operation in GPS group were improved (P<0.05). Conclusion The treatment effectiveness on choledocholithiasis of both GPS and LC is good,safe and feasible.GPS surgery can retain the function of the gallbladder,and improve the patient's quality of life,which is an alternative effective surgical procedure for gallstones.The personalized treatment can be performed on the basis on assessment of gallbladder condition and systemic state and willingness of patients.