腹腔镜再次胆道手术治疗胆总管结石的有效性及安全性分析

目的:评价腹腔镜再次胆道手术治疗胆总管结石的有效性和安全性。方法:将140例有胆道结石手术史需再次手术治疗胆总管结石的患者随机均分为两组,分别行腹腔镜手术(腹腔镜组)和开腹手术(开腹组),比较两组相关的手术指标。结果:与开腹组比较,腹腔镜组手术时间(117.5 min vs.125.3 min),术中出血量(67.3 m L vs.113.2 m L)、胃肠道功能恢复时间(25.3 h vs.55.2 h)及住院时间(6.9 d vs.12.4 d)均明显减少(均P0.05);住院费用高于开腹组(10 100元vs.9 600元),但差异无统计学意义(P0.05)。腹腔镜组术后镇痛例数(7例vs.17例)少于开腹组,切口感染发生率(2.9%vs.12.9%)低于开腹组(均P0.05),但胆瘘、胆道狭窄、结石残留、结石复发等发生率两组间差异无统计学意义(均P0.05)。结论:在有经验的临床医生指导下,充分的术前准备和评估加上术中的严谨细致的操作,腹腔镜在再次胆道手术治疗胆总管结石安全、有效,且出血量少、术后感染率低、恢复快。

Efficacy and safety of repeat biliary surgery for common bile duct stones by laparoscopic procedure

Objective: To assess the efficacy and safety of repeat biliary surgery for recurrent choledocholithiasis through laparoscopic procedure.Methods: One hundred and forty patients who had history of biliary surgery for bile duct stones and required repeat operation for recurrent choledocholithiasis were equally randomized into two groups, to receive laparoscopic (laparoscopic group) or open operation (laparotomy group), respectively. The main surgical variables between the two groups were compared.Results: In laparoscopic group compared with laparotomy group, the operative time (117.5 min vs. 125.3 min), intraoperative blood loss (67.3 mL vs. 113.2 mL), time to bowel function recovery (25.3 h vs. 55.2 h) and length of postoperative hospital stay (6.9 d vs. 12.4 d) were all significantly decreased (all P<0.05), while the hospitalization expense was increased (10 100 yuan vs. 9 600 yuan), but it did not reach a statistical significance (P>0.05). The number of patients using analgesics, and the incidence of wound infection in laparoscopic group were lower than those in laparotomy group (7 vs. 17; 2.9% vs. 12.9%, both P<0.05), while the incidence of bile leakage, biliary stricture, residual stone, and stone recurrence showed no statistical difference between the two groups (all P>0.05).Conclusion: Under the guidance of experienced surgeons, adequate preoperative preparation and assessment along with precise and meticulous operation, the repeat biliary surgery for recurrent choledocholithiasis by laparoscopic procedure is safe and effective, and also possesses the advantages of less bleeding, low incidence of postoperative infection and fast recovery.