腹腔镜下逆行胆囊切除和次胆囊切除在复杂胆管病变中的临床应用

目的 探讨腹腔镜下逆行胆囊切除和次胆囊切除在复杂胆管病变中的临床应用.方法 128例患者依照手术方式分为A、B两组,A组患者采用腹腔镜下逆行全胆囊切除手术,B组患者采用腹腔镜下逆行次胆囊切除手术,观察两组患者的手术时间、术中补液量、手术出血量、术后的胃肠道功能恢复时间、术后引流量、住院时间、胆管损伤以及胃十二指肠损伤.结果 B组在手术时间、术中补液量、手术出血量以及胆管损伤明显低于A组,P＜ 0.05;在术后的胃肠道功能恢复时间、术后引流量、住院时间以及胃十二指肠损伤与A组相比较差异无统计学意义,P＞ 0.05.结论 腹腔镜下逆行次胆囊切除术在复杂胆管病变中有较好的疗效,与逆行全胆囊切除术相比较具有出血量少、手术时间短、术中补液量少、操作简单、恢复快、无胆管及胃十二指肠损伤等并发症的优点.

The clinical effect of laparoscopic retrograde cholecystectomy and retrograde reserved cholecystectomy in complex bile duct lesions

Objective To discuss the clinical effect of laparoscopic retrograde cholecystectomy and retrograde reserved cholecystectomy in complex bile duct lesions. Methods 128 patients were divided into group A and group B according to surgical approach. Group A received laparoscopic retrograde cholecystectomy, while group B received laparoscopic retrograde reserved cholecystectomy. Compared operative time, intraoperative fluid volume （ml）, blood loss, gastrointestinal function recovery time, postoperative drainage, hospital stay, bile duct injury and gastroduodenal injury of two groups. Results Operative time, intraoperative fluid volume （ml）, blood loss and bile duct injury in group B were significantly lower than those in group A （P 〈 0.05）. There were no statistical significant differences in gastrointestinal function recovery time, postoperative drainage, hospital stay and gastroduodenal injury between two groups （P 〉 0.05）. Conclusions Laparoscopic retrograde reserved cholecystectomy is effective in complex bile duct lesions, with less bleeding, shorter operative time, less intraoperative fluid, simpler operation, quicker recovery compared with laparoscopic retrograde cholecystectomy, without bile duct injury or gastroduodenal complications.