不同微创术式治疗胆囊结石合并胆总管结石的临床研究

目的]探讨四微创方式治疗胆囊结石合并胆总管结石的疗效.方法]选择2009年1月至2011年1月微创方式治疗治疗胆囊结石合并胆总管结石的患者246例,分为腹腔镜胆道T管引流探查组92例（A组）,腹腔镜胆道探查一期缝合组42例（B组）,经胆囊管途径腹腔镜胆道探查术46例（C组）,腹腔镜胆囊切除加十二指肠乳头切开取石组66例（D组）,比较四组患者的手术并发症、术后住院天数、住院总天数、住院费用等.结果]A组腹腔引流时间、术后住院日、恢复正常工作时间、术后平均输液量、住院费用显著长于或高于其他三组（P〈0.05）,C组手术时间显著短于其他三组（P〈0.05）;D组术中出血量显著短于其他三组（P0.05）.结论]经胆囊管途径腹腔镜胆道探查术（C组）安全可靠,手术创伤小,体现出微创外科技术的优越性,值得临床推广,腹腔镜胆道T管引流探查术,腹腔镜胆道探查一期缝合组术,腹腔镜胆囊切除加十二指肠乳头切开取石组术式作为必要的补充方式,四种术式各有优缺点,应根据患者具体情况,个性化治疗.

Clinical Research on Different Minimally Invasive Surgery for the Treatment of Cholecystolithiasis Complicated with Common Bile Duct Calculi

Objective]To explore the efficacy of four different minimally invasive methods for the treatment of cholecystolithiasis complicated with common bile duct calculi. Methods] Totally 246 patients with cholecystolithiasis complicated by common bile duct stones undergoing minimally invasive operation from January 2009 to January 2011 were digided into laparoscopic duct T-tube drainage and exploration group（group A, n =92）, laparoscopic duct exploration and primary suture group（group 13, n =42）, transcystic laparoscopic common bile duct exploration（rLCBDE） group（group C, n =46） and laparoscopic cholecystectomy and endoscopic sphincterotomy group（group D, n=66）. Complications, hospital day after operation and hospital cost were compared among four groups. Results]The duration of peritoneal drainage, hospital day after operation, recovery time, average postoperative transfusion volume and hospital cost in group A were significantly higher than those in other three groups（ P 〈0.05）. Blood loss volume in group D was obviously less than those in other three groups（ P 〈0.05）. The incidence of complications in group A（10.9%, 10/92） was significantly higher than those in group B（4.8%, 2/42）, group C（4.3%, 2/46） and group D（3.0%, 2/66） （ P d0.05）, but there was no significant difference among group B, group C and group D（ P 〉0.05）. Conclusion] The rLCBDE is safe and reliable with minimal trauma, so it has the advantages of minimally invasive surgical tech- nology and worthy of clinical promotion. Laparoscopic duct T-tube drainage and exploration, laparoscopie bilary duct exploration and primary structure, laparoscopic cholecystectomy and endoscopic sphincterotomy can be used as the necessary supplement. The four methods have their own advantages and disadvantages. Patients receive individualized therapy by their specific situation.