| 三种联合术治疗胆总管结石的临床疗效及安全性比较 |
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| 引用本文： | 陈明,伍三兰. 三种联合术治疗胆总管结石的临床疗效及安全性比较[J]. 中华普外科手术学杂志(电子版), 2020, 14(3): 306-309. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.026 |
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| 作者姓名： | 陈明 伍三兰 |
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| 作者单位： | 1. 110031 中国医科大学附属盛京医院普外科2. 430030 华中科技大学同济医学院附属协和医院肝胆外科 |
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| 摘 要： | 目的比较三种联合术治疗胆总管结石的临床疗效及安全性。 方法回顾性分析2014年10月至2016年10月81例胆总管结石患者资料，根据手术方式不同分为三组，分别为A组(腹腔镜胆囊切除和经胆囊管胆道探查)；B组(腹腔镜胆囊切除＋胆总管切开探查＋胆管一期缝合)；C组(腹腔镜胆囊切除＋胆总管切开探查＋T管引流)，各27例。采用SPSS20.0软件进行统计分析，围术期各项指标等计量资料以( ±s)描述，两组间t检验，三组间经方差齐性检验分析；治疗效果秩和检验；术后并发症情况等计数资料采用χ2检验。P<0.05差异有统计学意义。 结果A组患者的手术时间、腹腔引流时间、住院时间、住院费用及恢复正常生活时间等指标均明显优于B组和C组，而B组的上述各项指标均优于C组(P<0.05)；三组患者的疗效经比较，A组的治疗总有效率明显高于C组患者(92.6% vs. 63.0%, P<0.05)，但A组与B组，B组与C组间的治疗总有效率差异无统计学意义(92.6% vs. 74.1%；74.1% vs. 63.0% P>0.05)；三组患者的胆道感染、胆汁渗漏、肺部感染、腹腔积液以及脓肿形成等术后并发症的发生率差异无统计学意义(P>0.05)。 结论三种联合术治疗胆总管结石均有各自的适应证。综合来看，腹腔镜胆囊切除联合经胆囊管胆道探查术治疗胆总管结石患者的疗效最优，其次为腹腔镜胆囊切除联合胆总管切开探查并进行胆管一期缝合。
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| 关 键 词： | 胆总管结石 腹腔镜 胆囊切除术 疗效比较研究 安全 |
| 收稿时间： | 2019-08-26 |
Comparative study of clinical efficacy and safety of three kinds of combined surgery for common bile duct stones |
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| Ming Chen,Sanlan Wu. Comparative study of clinical efficacy and safety of three kinds of combined surgery for common bile duct stones[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Version, 2020, 14(3): 306-309. DOI: 10.3877/cma.j.issn.1674-3946.2020.03.026 |
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| Authors: | Ming Chen Sanlan Wu |
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| Affiliation: | 1. Department of General Surgery, Shengjing Hospital, China Medical University, Liaoning 110031, China2. Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei 430030, China |
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| Abstract: | ObjectiveTo compare the clinical efficacy and safety of three kinds of combined surgery for common bile duct stones. MethodsA retrospective analysis was performed in 81 cases of common bile duct stones from October 2014 to October 2016, who were divided into three groups according to the surgical treatments. There were 27 cases in group A (laparoscopic cholecystectomy and cystic duct exploration); 27 cases in Group B (laparoscopic cholecystectomy+ common bile duct exploration+ bile duct primary suture) and 27 cases in Group C (laparoscopic cholecystectomy+ common bile duct exploration+ T tube drainage). The measurement data such as the perioperative indicatores were described as ( ±s), and were examined by using t test, while the three groups were analyzed by Homogeneity test of variance. Count data such as treatment effect and postoperative complications were analyzed by χ2 test. A value of P<0.05 was considered as significant difference. ResultsCompare with group B and C, there were significant advantages in group A, in terms of the operation time, drainage time, hospital stay, medical cost and recovery time to normal life, while the above indicators in group B were all better than those in group C respectively (P<0.05); After comparing the efficacy of the three groups of patients, the total effective rate of treatment in group A was significantly higher than that in group C (92.6% vs. 63.0%, P<0.05). However, there was no significant difference in the total treatment efficiency between group A and group B, group B and group C (92.6% vs. 74.1%, 74.1% vs. 63.0% respectively, P>0.05). There were no significant difference between three groups in terms of the incidence of postoperative complications such as biliary tract infection, bile leakage, pulmonary infection, peritoneal effusion and abscess formation (P>0.05). ConclusionThree kinds of combined surgery for common bile duct stones have their own indications. Taken together, laparoscopic cholecystectomy combined with cystic duct exploration for the treatment of common bile duct stones was the best choice, followed by laparoscopic cholecystectomy combined with common bile duct exploration and primary bile duct suturing. |
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| Keywords: | Choledocholithiasis Laparoscopes Cholecystectomy Comparative effectiveness research Safety |
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