三种术式行胆总管切开取石术的对比研究  

A comparative study of three surgical methods for choledocholithotomy

作　　者：唐荣[1] 张绍庚[1] 赵新[1] 刘虎[1] 赵德希[1] 

机构地区：[1]福建医科大学福州总医院临床医学院肝胆外科,福建福州350025

出　　处：《中国普通外科杂志》2012年第2期132-135,共4页China Journal of General Surgery

摘　　要：目的:比较完全腹腔镜手术、小切口手术及开腹手术行胆总管切开取石术的临床效果。方法:回顾性分析近5年胆囊结石合并胆总管结石手术治疗的217例患者的临床资料,其中,行腹腔镜胆囊切除(LC)+腹腔镜下胆总管切开取石术(LCBDE)69例(腹腔镜组);行LC+小切口胆总管切开取石术85例(小切口组);行开腹胆囊切除+胆总管切口取石术63例(开腹组)。对比3组间的相关临床指标。结果:腹腔镜组、小切口组在术中出血量、术后肠道功能恢复时间、术后疼痛、并发症发生率以及术后住院时间上明显优于开腹组(均P<0.05),小切口组在手术时间及气腹时间上明显少于腹腔镜组(均P<0.05)。结论:LCBDE及辅助小切口手术都具有创伤小、恢复快、痛苦少等优点。与LCBDE相比,小切口手术减少了手术时间及术中气腹时间,尤其适用于不能耐受长时间气腹及心肺功能较差的年老患者。Objective： To compare the dinical efficacies among laparoscopic, minilaparotomy and conventional open choledocholithotomy. Methods： The clinical data of 217 patients with cholecystolithiasis and choledocholithiasis undergoing surgical treatment in recent five years were analyzed. Of the patients, 69 cases underwent laparoscopicprocedure （laparoscopic group）, laparoscopic cholecystectomy （LC） plus laparoscopic common bile duct exploration （LCBDE）; 85 cases underwent minilaparotomy surgery （minilaparotomy group）, LC plus open choledocholithotomy via a small laparotomy incision; and 63 cases underwent conventional open surgery（open surgery group）, open cholecystectomy and choledocholithotomy. The related clinical indexes among the three groups were compared and analyzed. Results： The intraoperative bleeding volume, time to bowel function recovery, postoperative pain, complication incidence and hospital stay of the laparoscopic group and minilaparotomy group were significantly better thanthose of the open surgery group. The average time of operation and pneumoperitoneum in the minilaparotomy group were shorter than those in the laparoscopic group （both P〈0.05）. Conclusion： Both LCBDE and auxiliary minilaparotomy quicker recovery and less pain. Minilaparotomy procedure surgery have the advantages of minimal invasion, can shorten the operative and pneumoperitoneum time compared with LCBDE, so it is especially suitable for patients who cannot tolerate a long pneumoperitoneum time and elderly patients with poor cardiopulmonary function.

关 键 词：胆总管结石/外科学 胆总管切开术 腹腔镜 对比研究 

分 类 号：R657.4[医药卫生—外科学]