腹腔镜联合胆道镜治疗胆总管结石合并胆囊良性疾病

目的:探讨腹腔镜联合胆道镜治疗胆总管结石并胆囊良性疾病的临床疗效及并发症的防治。方法:回顾分析为24例胆总管结石并胆囊良性疾病患者行腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)(腔镜组)、为30例患者行传统开腹胆总管探查(open common bile duct exploration,OCBDE)+胆囊切除(open cholecystectomy,OC)(开腹组)的临床资料,对比分析两组手术时间、术后疼痛评分、术后下床活动时间、术后住院时间、T管拔除时间、手术成功率、术后并发症发生率及住院费用等指标。结果:腔镜组与开腹组手术时间(119.17±27.84)min vs.(97.83±24.41)min]、术后疼痛评分(4.50±0.72)分vs.(8.23±0.86)分]、术后下床活动时间(12.17±4.43)h vs.(31.2±12.32)h]、术后住院时间(10.33±3.29)d vs.(14.37±3.09)d]、拔T管时间(44.33±12.02)d vs.(33.50±9.61)d],差异均有统计学意义(P<0.05)。腔镜组与开腹组住院费用(21 934±3 756)元vs.(24 148±7 112)元]差异无统计学意义(P>0.05)。两组手术成功率差异无统计学意义(χ2=0.635,P>0.05),术后并发症发生率差异有统计学意义(χ2=4.055,P<0.05)。结论:腹腔镜联合胆道镜治疗胆总管结石合并胆囊良性疾病不仅安全有效,而且患者术后疼痛轻、康复快,正确的认识与处理并发症对预后至关重要。

Laparoscopy combined with choledochoscopy in the treatment of choledocholithiasis and benign gallbladder diseases

Objective： To explore the clinical effectiveness,prevention and treatment of complications of laparoscopy combined with choledochoscopy in patients with choledocholithiasis and benign gallbladder diseases. Methods： From Jan. 2011 to Jan. 2014,patients with choledocholithiasis and benign gallbladder diseases were treated by either laparoscopic cholecystectomy（ LC） ＋ laparoscopic common bile duct exploration（ LCBDE）（ n = 24） or traditional open surgery（ n = 30）. The operation time,postoperative pain score,postoperative ambulation time,postoperative hospital stay,T tube removal time,operation success rate,postoperative complications rate and cost of hospitalization in 2 groups were comparatively analyzed. Results： Between laparoscopic group and open group,operation time（ 119.17 ±72.84） min vs.（97.83 ±24.41） min],postoperative pain score （4.50 ±0.72） vs.（8.23 ±0.86） ],postoperative ambulation time （ 12. 17 ± 4. 43） h vs.（ 31. 2 ± 12. 32） h],postoperative hospital stay （ 10. 33 ± 3. 29） d vs.（ 14. 37 ± 3. 09） d],T tube removal time （ 44. 33 ± 12. 02） d vs.（ 33. 50 ± 9. 61） d],their differences were statistically significant（ P〈 0. 05）. The cost for hospitalization between the two groups （ 21 934 ± 3 756） yuan vs.（ 24 148 ± 7 112） yuan] were not significantly different（ P〉 0. 05）. The result showed that the treatment success rate between the laparoscopic group and open surgical group was not significantly different（ χ2= 0. 635,P〉 0. 05）. There was a significant difference in the incidences of postoperative complications between two groups（ χ2= 4. 055,P〈 0. 05）. Conclusions： Laparoscopy combined with choledochoscopy is not only safe and efficacious,but also with little postoperative pain,fast rehabilitation for choledocholithiasis and benign gallbladder diseases. Correct recognition and treatment of the complications are very important for prognosis.