完全腹腔镜保胆取石术治疗慢性结石性胆囊炎效果评价

目的 评估完全腹腔镜保胆取石术的安全性及可行性.方法 选取南通市第三人民医院34例完全腹腔镜保胆取石术患者(保胆组)及同期34例腹腔镜胆囊切除术患者(切胆组),进行对比分析,并进行术后随访.结果 手术时间在保胆组明显延长(124.56 min vs 78.50 min,P＜0.01);平均住院费用在保胆组明显增加(10 970.85元vs 8 666.72元,P＜0.01);保胆组术后发生腹泻或腹胀的患者例数少于切胆组,但结果差异无统计学意义(2例vs6例,P =0.26);术中情况及术后随访结果,包括术中出血量、术后住院时间、术后肛门排气时间、术后腹腔内出血例数、术后胆漏例数及术后切口感染例数差异无统计学意义;在随访过程中,保胆组有1例患者结石复发,在切胆组未出现再患胆总管结石患者.结论 完全腹腔镜保胆取石术治疗慢性结石性胆囊炎是安全有效的,尤其适合有医疗保险的患者.然而,这种治疗方式有一定的技术要求,并且实施手术的外科医师需要有一定的经验.

Totally laparoscopic cholecystolithotomy as a treatment for chronic calcular cholecystitis: a case-control study

Objective To evaluate the safety and feasibility of totally laparoscopic cholecystolithotomy.Methods Patient baseline characteristics of all 34 totally laparoscopic cholecystolithotomy (TLC) were collected in a database.This group was compared with 34 matched patients who underwent the laparoscopic cholecystectomy (LC) in the same period.Retrospectively,intraoperative and postoperative data were added.Results Operatingtime was significantly longer in the TLC group(124.56 min vs 78.50 min,P ＜0.01).The mean hospitalization expenses of operation was significantly higher in the TLC group(10 970.85 yuan vs 8 666.72 yuan,P ＜0.01).Although not significant less patients have the symptoms of postoperative dyspepsia or diarrhea were seen in the TLC group compared with the LC group (2 vs 6,P =0.26).Intraoperative details and postoperative results such as,blood loss,hospital stay,exhaust time,abdominal bleeding,bile leakage,incision infection have no significant difference.One case of gallstone recurrence was detected in TLC group.No stone recurrence was reported in common bile duct in LC group.Conclusions TLC is effective and feasible for chronic calcular cholecystitis and is particularly favorable for thepatients with medical insurance.However,this approach is technically demanding and should be performed by experienced surgon.