腹腔镜胆囊切除和保胆取石术治疗胆囊结石的前瞻和对照性研究  

Clinical outcome of laparoscopic combined choledoscopic cholecystolithotomy and laparoscopic cholecystectomy

作　　者：姚国相[1] 刘海军[1] 姚凯[1] 顾铮[1] 张吉发[1] 单远州[1] 郁林海[2] 张学利[1] 

机构地区：[1]上海交通大学附属第六人民医院南院普外科,201499 [2]上海中医药大学附属曙光医院松江分院普外科

出　　处：《腹部外科》2013年第5期329-332,共4页Journal of Abdominal Surgery

摘　　要：目的 比较5年来腹腔镜胆囊切除术（LC）和腹腔镜联合胆道镜保胆取石术（LCCC）治疗胆囊结石的疗效.方法 将400例胆囊结石患者,在知情同意的情况下分为LCCC组（200例）和LC组（200例）.对两组的手术时间、术后住院时间、住院费用、术后症状和结石复发等因素进行分析.结果 LCCC组与LC组比较,手术时间长[（53.6±15.2） min与（29.4±10.8） min,P＜0.05）];术后住院时间差异无统计学意义.两组术后随访5年,平均3.8年.正常饮食情况下,LCCC组无腹泻症状,LC组术后出现腹泻症状者110例（55%）,差异有统计学意义（P＜0.01）,患者必须服用低脂饮食以缓解腹泻症状.技术开展初期（3个月）,经复查B超发现LCCC组结石残留4例（2%）,复发结石4例（2%）.两组住院费用差异无统计学意义.结论 LCCC较LC手术时间稍长,术后住院时间无明显差异.保胆手术复发和结石残留率低,无胆囊切除后的腹泻症状.保胆手术保留了患者的器官,值得进一步探索.Objective Iaparoscopic cholecystectomy（LC） is a routine procedure for gallbladder stone,cholecystolithotomy（LCCC） is recently a new method. Clinical outcome of LCCC and LC were compared. Methods A prospective, randomized, no-blind clinical oberservation were carried out. 200 patients with gallbladder stones were divided into LCCC group （100 cases） and LC group （100 cases）. Operative time, postoperative inpatient time and postoperative symptoms and relapse were documen- ted. Results The operative time of the LCCC was longer than LC [（53.6 ± 15.2） min VS （29. 4 ± 10. 8） rain, P〈0. 05]. No differences were found on postoperative time and other immediate complica- tions. Patients were followed up 5 years, 110 cases of diarrhea（55%） were found in the LC group in compare with none in the LCCC group （P〈0.05）; 4 cases of relapse and 4 cases of residual were found in the LCCC group in compare with none in the LC group. The cost of each group is the same. Conclusion LCCC takes more time than LC but has no diarrhea and other complications, with no differences on postoperative stay and other clinical data. Postoperative diarrhea occurs in 55% of pa- ttens with LC while none in LCCC. Although LCCC preserves the organ and is beneficial, it is warran- ted to carry out more study.

关 键 词：胆囊结石病 胆囊切除术 腹腔镜 腹腔镜联合胆道镜保胆取石 

分 类 号：R657.4[医药卫生—外科学]