微创内镜保胆取息肉术与腹腔镜胆囊切除术治疗胆囊息肉的对比研究  

Endoscopic minimally invasive polypectomy with gallbladder preservation versus laparoscopic cholecystectomy for gallbladder polyps

作　　者：李之令[1,2] 张东[1] 刘江伟[1] 王皓[1] 

机构地区：[1]中国人民解放军兰州军区乌鲁木齐总医院肝胆外科,新疆乌鲁木齐830000 [2]新疆医科大学研究生院,新疆乌鲁木齐830000

出　　处：《中国普通外科杂志》2013年第2期188-191,共4页China Journal of General Surgery

基　　金：新疆维吾尔自治区科技计划项目(201042145)

摘　　要：目的:比较内镜微创保胆取息肉术与腹腔镜胆囊切除术治疗胆囊息肉的临床疗效。方法:将2009年2月—2012年4月收治的196例符合条件的胆囊息肉患者,根据患者意愿分为内镜微创保胆取息肉术组(保胆组,103例)和腹腔镜胆囊切除术组(胆囊切除组,93例),比较两组术中及术后的情况。结果:两组在年龄、性别、合并症上差异均无统计学意义(均P>0.05),具有可比性。保胆组2例因术中取息肉后胆囊壁出血明显,改行胆囊切除术。与胆囊切除组比较,保胆组平均手术时间、术中出血量减少[(50.3±12.9)min vs.(61.2±16.7)min;(10.2±2.7)mL vs.(15.1±3.9)mL];术后疼痛、消化道不良反应发生率减少、首次排气时间缩短[16.83%vs.32.26%;18.81%vs.3.33%;(18.5±4.1)h vs.(26.2±5.3)h];远期并发症发生率减少(10.89%vs.22.58%)(均P<0.05)。结论:内镜微创保胆取息肉术较腹腔镜胆囊切除术痛苦轻、康复快、手术并发症少,对符合适应症的患者是一种安全、有效的术式。Objective： To compare the clinical efficacies between endoscopic minimally invasive polypectomy with gallbladder preservation and laparoscopic cholecystectomy in treatment of gallbladder polyps.Methods： One hundred and ninety-six patients with gallbladder polyps who met our criteria were designated to undergo either endoscopic minimally invasive gallbladder preserving polypectomy （gallbladder preservation group, 103 cases） or laparoscopic cholecystectomy （cholecystectomy group, 93 cases） depending on the their own willingness. The intra- and postoperative conditions of the patients between the two groups were compared. Results： There were no significant differences between the two groups with regard to age, sex and comorbidities （all P〉0.05）, so they were comparable. Two patients in gallbladder preservation group were converted to perform cholecystectomy due to gallbladder wall hemorrhage after polypectomy. Compared with cholecystectomy group, in gallbladder preservation group, the average operative time and intraoperative blood loss were reduced [（50.3±12.9） min vs. （61.2±16.7） min; （10.2±2.7） mL vs. （15.1±3.9） mL]; the incidences of postoperative pain and gastrointestinal adverse reactions were decreased, and time to the first intestinal gas passage was shortened [16.83% vs. 32.26%; 18.81% vs. 3.33%; （18.5±4.1） h vs. （26.2±5.3） hi; the incidence of long-term complications were also decreased （10.89% vs. 22.58%） （all P〈0.05）. Conclusion： The minimally invasive endoscopic gallbladder preserving polypectomy has the advantages of less pain, fast recovery and fewer complications compared with laparoscopic cholecystectom）5 and so it is a safe and effective treatment method for patients with suitable indications.

关 键 词：胆囊疾病 外科学 息肉 胆囊切除术 腹腔镜 保胆取息肉术 

分 类 号：R657.4[医药卫生—外科学]