开腹手术与腹腔镜手术行胆总管切开取石的疗效研究

目的：探讨开腹手术与腹腔镜手术行胆总管切开取石的临床效果。方法：将127例胆囊结石合并胆总管结石患者随机分为治疗组（腹腔镜手术组,64例）和对照组（开腹手术组,63例）,分析对比两组患者的术中、术后情况。结果：两组手术均获成功。对照组平均手术时间（100±30）min,术中失血量（200±50）ml,术后肛门平均排气时间（59.2±18.5）h,术后平均住院时间（13.2±3.9）d,术后疼痛33例,切口感染5例;治疗组平均手术时间（80±25）min,术中失血量（100±50）ml,术后肛门平均排气时间（17.8±4.1）h,术后平均住院时间（6.1±2.8）d,术后疼痛8例,无切口感染病例,与对照组比较,术中失血量、术后疼痛例数、术后肛门平均排气时间、术后平均住院时间,差异均有统计学意义（均P〈0.05）,两组均无T管造影残余结石和胆漏发生。结论：腹腔镜手术创伤小、效果好,能取代大部分开腹胆总管取石术。

Therapeutic efficacy study of laparotomy and laparoscopic choledocholithotomy

Objective： To study the clinical effects of laparotomy and laparoscopic choledocholithotomy.Methods： 127 cases of gallbladder stones combined with biliary stones were randomly assigned to the treatment group（laparoscopic surgery group,64 cases） and the control group（laparotomy group,63 cases）.Patient condition during and after operation were compared between the two groups.Results： Surgeries in both groups were successful.In control group,mean operation time was（100±30）min,blood loss was（200±50）ml,mean anal exhaust time was（59.2±18.5）h and mean postoperative hospital stay was（13.2±3.9）d,there were 33 cases of postoperative pain and 5 cases of wound infection.In the treatment group,mean operation time was（80±25）min,blood loss was（100±50）ml,mean anal exhaust time was（17.8±4.1）h and the mean hospital stay was（6.1±2.8）d,there were 8 cases of postoperative pain and no wound infections were observed in this group.There were significant differences between the two groups in volume of blood loss,number of cases of postoperative pain,mean anal exhaust time and mean postoperative hospital stay（all P〈0.05）.No residual stone and bile leakage were observed with T tube cholangiography in two groups.Conclusion： Laparoscopic surgery is minimally invasive and therapeutically effective,which can replace most of the laparotomy common bile duct stone removal surgery.