腹腔镜胆囊切除术与小切口下胆道镜保胆取石术比较分析

目的比较腹腔镜胆囊切除术与小切口下胆道镜保胆取石术的临床治疗效果,对两种手术方式的近期指标及远期评价进行评价分析。方法选取该院2008年6月—2012年6月收治的822例胆囊结石手术患者为研究对象,根据手术方式分为腹腔镜胆囊切除组（744例）和保胆取石组（78例）,对两组患者手术时间、住院时间、术后并发症及复发情况进行回顾性分析。结果保胆取石组平均手术用时为（85.26±20.08）min,高于腹腔镜胆囊切除组的（60.43±15.61）min,保胆取石组平均住院时间为（6.89±1.96）d,高于腹腔镜胆囊切除组的（4.97±1.34）d,组间差异有统计学意义（P〈0.05）,两组均未见术后感染、胆漏、出血等术后并发症。保胆取石组术后结石复发15例,复发率为19.23%,腹腔镜胆囊切除未见复发。结论小切口下胆道镜保胆取石术虽然在手术时间、住院时间等、复发率等方面均高于腹腔镜胆囊切除术,但具有保留胆囊生理功能的优势,且未见术后并发症。在严格遵守手术适应症的情况下,腹腔镜胆囊切除术和小切口下胆道镜保胆取石术均可所谓胆囊结石的手术方式。

Comparative Analysis of Laparoscopic Cholecystectomy and Small Incision Cholangioscopic Cholecystolithotomy

Objective To compare the clinical treatment effect between laparoscopic cholecystectomy and small incision cholangioscopic cholecystolithotomy, and evaluate and analyze the short-term indexes and long-term evaluation of these two surgical methods. Methods 822 patients underwent gallstone surgery in our hospital from June 2008 to June 2012 were selected as the subjects and divided into laparoscopic cholecystectomy group （744 cases） and Paul gall stone group （78 cases） according to the surgical mode. And the operative time, hospital stay, postoperative complications and recurrence of these two groups of patients were analyzed retrospectively. Results The average operative time of the Paul gall stone surgery group was （85.26±20.08） min, longer than （60.43±15.61） min of the laparoscopic cholecystectomy group; the average length of stay of the Paul gall stone surgery group was （6.89±1.96） d, longer than （4.97±1.34） d of the laparoscopic cholecystectomy group, the differences between the two groups were statistically significant （P〈0.05）. The two groups showed no postoperative infection, bile leakage, bleeding and other postoperative complications. There were 15 cases of stone recurrence in the Paul gall stone group, the recurrence rate was 19.23%, but the laparoscopic cholecystectomy group had no recurrence. Conclusion Although the operative time and length of stay of small incision cholangioscopic cholecystolithotomy are longer than those of the laparoscopic cholecystectomy, and the recurrence rate is higher than that of the laparoscopic cholecystectomy, it has the advantage of preserving the physiological function of gallbladder without postoperative complications. In the case of strict compliance with the indications for surgery, both laparoscopic cholecystectomy and small incision cholangioscopic cholecystolithotomy can be as the surgical modes of cholecystolithiasis.