腹腔镜与开腹手术治疗肝内胆管结石的对比研究

目的探讨腹腔镜治疗肝内胆管结石的可行性、安全性及适应证。方法对2003年7月～2008年1月肝内胆管结石腹腔镜组（n=30）与开腹组（n=30）的手术时间、术中出血量、胃肠功能恢复时间、住院时间、术后镇痛药使用率、术后低蛋白血症发生率、切口感染率等进行统计分析。结果与开腹组相比,腹腔镜组手术时间长（243.2±89.5）min、（180.5±104.5）min,t=2.496,P=0.015],但术中出血量少（99.7±88.0）ml、（557.9±250.0）ml,t=-9.469,P=0.000],术后镇痛剂使用率低26.7%（8/30）、60.0%（18/30）,χ^2=6.787,P=0.009],术后排气早（56.3±26.0）h、（90.7±28.0）h,t=-4.931,P=0.000],住院时间短（15.7±5.2）d、（23.8±12.4）d,t=-3.299,P=0.002],术后低蛋白血症发生率低6.7%（2/30）、33.3%（10/30）,χ^2=6.667,P=0.010],切口感染率低0%（0/30）、26.7%（8/30）,χ^2=9.231,P=0.002]。2组随访3～63个月,均无残存结石和复发。结论腹腔镜治疗肝内胆管结石安全、可靠,手术创伤小,住院时间短,恢复快。

Comparison between Laparoscopic and Open Surgeries for Intrahepatic Bile Duct Stone

Objective To investigate the feasibility, safety, and indication of laparoscopic treatment for intrahepatic bile duct stone. Methods A total of 60 patients with bile duct stone, who were treated in our hospital from July 2003 to January 2008 were enrolled in this study. The patients were divided into laparoseopy （n = 30） and laparotomy groups （n = 30）. Their operation time, and intraoperative blood loss, recovery time of gastrointestinal function, hospitalization time, and postoperative rates of analgesics usage, incidence of hypoproteinemia, and wound infection were analyzed statstieally. Results Compared to the laparotomy group, the patients in the laparoscopy group had longer operation time （243.2 ±89.5 ） min vs （ 180. 5 ± 104.5 ） rain, t = 2. 496, P = 0. 015 ], less intraoperative blood loss （99.7 ± 88.0） ml vs （557.9 ±250.0） ml, t=-9.469, P =0.000], quicker recovery of the gastrointestinal function （56.3± 26.0） h vs （90. 7 ± 28.0） h, t = - 4.931, P = 0. 000 ] , shorter hospitalization （ 15.7 ± 5.2） d vs （23.8±12.4） d, t= -3.299, P =0.002], and lower rates of analgesics usage 26.7% （8/30） vs 60. 0% （18/30）,X^2 = 6. 787, P=0.009], hypoproteinemia 6.7% （2/30） vs 33.3% （10/30）,X^2 =6.667, P=0.010], and wound infection 0% （0/30） , 26.7% （8/30）, X^2 =9. 231, P = 0. 002]. The patients were followed up for 3 to 63 months, during which no one had residual stones or developed recurrence. Conclusions Laparoscopy is safe, effective, and minimally invasive for the patients with intrahepatic bile duct stone. The postoperative hospital stay is short after the procedure.