微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的对比研究

目的探讨微创保胆取石术联合牛磺熊去氧胆酸与腹腔镜胆囊切除术治疗胆囊结石的疗效。方法统计贵阳医学院附属医院2011年5月至2012年5月收治的微创保胆取石治疗胆结石患者100例和腹腔镜胆囊切除治疗胆结石患者173例,保胆患者作为治疗组术后均口服牛磺熊去氧胆酸,胆囊切除患者作为对照组术后给予常规抗炎支持治疗,所有患者术后平均随访时间为1年,统计各组患者胆石症状改善情况和治疗组患者的胆囊壁厚、胆囊功能水平和结石复发率。结果治疗组患者手术前胆绞痛、腹胀、右上腹不适发生率分别为47.1%、21.8%、100%,胆囊壁厚为(3.42±0.49)mm,手术后1年胆绞痛、腹胀、右上腹不适发生率分别为2.3%、9.2%、2.3%,胆囊壁厚为(2.57±0.69)mm;胆囊结石患者组胆囊排空指数为43.11±20.82,保胆取石术后两年患者组胆囊排空指数为56.00±10.77,正常组胆囊排空指数为56.65±13.45,患者手术前后胆石症状、胆囊壁厚的差异均具有统计学意义(P<0.05),保胆取石术后两年患者组胆囊排空指数与正常组差异无统计学意义(P>0.05),而与胆囊结石组患者组差异有统计学意义(P<0.05);术后1年治疗组患者腹泻、腹胀、右上腹不适症状发生率分别为2.3%、9.2%、2.3%,对照组患者腹泻、腹胀、右上腹不适症状发生率分别为33.6%、25.5%、17.3%,两组之间胆石症状的差异均具有统计学意义(P<0.05),治疗组患者术后胆固醇结石复发率有降低趋势。结论保胆取石术后口服牛磺熊去氧胆酸对术后患者胆囊功能的恢复及预防胆囊胆固醇结石的复发有重要意义。

Contrastive study for treatment of cholecystolithiasis by minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid and laparoscopic cholecystectomy

Objective To explore the therapeutic effects for treatment of cholecystolithiasis by minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid and laparoscopic cholecystectomy. Methods 100 patients with cholecystolithiasis who received minimally invasive cholecystolithotomy with gallbladder reservation and 173 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy in The Affiliated Hospital of Guiyang Medical College from May 2011 to May 2013. Patients who underwent minimally invasive cholecystolithotomy with gallbladder reservation as trial group were given TUDCA after surgery, patients who received LC as control group were given conventional antiinflammatory therapy after surgery. the overall follow-up period is 1 year. Then we statistically analyze improvement of cholelith symptoms in every group, thickness of gall bladder wall, contraction function of the gallbladder and recurrence rate of cholesterol gallstone in trial group. Results There was significant difference in trial group between pre-operation and post-operation in terms of the rate of cholelith symptoms, thickness of gall bladder wall and the contraction function of gallbladder （P〈0.05）. There was significant difference between trial group and control group 1 year after surgery in terms of the rate of cholelith symptoms（P〈0.05）, the rate of the recurrence of cholesterol gallstone was decreased in the trial group. Conclusion Minimally invasive cholecystolithotomy with gallbladder reservation combined tauroursodeoxycholic acid is meaningful for recovering the function of gallbladder and preventing postoperative recurrence of cholesterol gallstone.