胆囊结石并胆总管结石患者行微创手术和开腹手术的疗效比较  

Comparison of minimally invasive operation versus open surgery in the treatment of common bile duct stones and gallbladder stones

作　　者：林鸿坡 程锐[1] 陈燕凌[1] 周浩辉[1] 洪海杰[1] 王弼[1] LIN Hongpo;CHENG Rui;CHEN Yanling;ZHOU Haohui;HONG Haijie;WANG Bi(Department of Hepatobzliary Surgery,Fujian Medical University Union Hospital,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院肝胆外科,福州350000

出　　处：《中华实用诊断与治疗杂志》2019年第1期37-39,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家卫生和计划生育委员会公益性行业科研专项(201502014)

摘　　要：目的比较微创手术、开腹手术治疗胆囊结石并胆总管结石的效果。方法胆囊结石并胆总管结石患者155例,依据胆总管结石直径分为A组(结石直径10～20mm)78例、B组(结石直径<10mm)77例。A组行微创手术38例,开腹手术40例;B组行微创手术46例,开腹手术31例。微创术式为内镜十二指肠乳头括约肌切开术/内镜十二指肠乳头球囊扩张术+腹腔镜胆囊切除术,开腹术式为胆囊切除+胆总管切开取石T管引流术。比较2组住院时间、手术时间、术中出血量、胆总管结石清除率及并发症发生情况。结果 A组行微创手术者手术时间[(104.23±37.70)min]较行开腹手术者[(181.08±34.19)min]短,术中出血量[(17.24±9.49)mL]较行开腹手术者[(90.25±51.35)mL]少(P<0.05),住院时间[(20.08±5.61)d]、结石清除率(94.7%)、并发症发生率(10.5%)与行开腹手术者[(17.55±6.81)d、100.0%、10.0%]比较差异无统计学意义(P>0.05);B组行微创手术者手术时间[(102.68±18.69)min]较行开腹手术者[(154.54±44.16)min]短,术中出血量[(15.67±10.94)mL]较行开腹手术者[(60.00±29.69)mL]少(P<0.05),住院时间[(16.59±7.11)d]、结石清除率(97.8%)、并发症发生率(2.2%)与行开腹手术者[(15.10±2.86)d、100.0%、0]比较差异无统计学意义(P>0.05)。结论对胆总管结石并胆囊结石并患者,行内镜十二指肠乳头括约肌切开术/内镜十二指肠乳头球囊扩张术+腹腔镜胆囊切除术可取得与胆囊切除+胆总管切开取石T管引流术相同的效果,且具有手术时间短、术中出血量少的优势。Objective To compare the outcomes of minimally invasive operation versus traditional open surgery for common bile duct stones and gallbladder stones.Methods Totally 155 patients with common bile duct stones and gallbladder stones were divided into 78 patients with stone 10 to 20 mm in diameter(group A)and 77 patients with stone<10mm in diameter(group B)according to common bile duct stones diameter.In group A,38 patients were performed endoscopic duodenal papillary sphincter incision/endoscopic duodenal papillary balloon dilatation+laparoscopic cholecystectomy(EST/EPBD+LC)and 40 were performed open cholecystectomy+common bile duct incision with T-tube drainage(OC+OCHTD),while in group B,46 patients were performed EST/EPBD+LC and 31 were performed OC+ OCHTD.The hospital stay,operative time,intraoperative blood loss,stone clearance rate and complication incidence were compared.Results EST/EPBD+LC had shorter operative time((104.23±37.70)min)and less intraoperative blood loss((17.24±9.49)mL)compared with OC+OCHTD((181.08±34.19)min,(90.25±51.35)mL)(P<0.05),while there were no significant differences in hospital stay((20.08±5.61)d vs.(17.55±6.81)d),stone clearance rate(94.7% vs.100.0%)and incidence of complication(10.5% vs.10.0%)between two methods in group A(P>0.05).EST/EPBD+LC had shorter operative time((102.68±18.69)min)and less intraoperative blood loss((15.67±10.94)mL)compared with OC+OCHTD((154.54±44.16)min,(60.00±29.69)mL)(P<0.05),while there were no significant differences in hospital stay((16.59±7.11)d vs.(15.10±2.86)d),stone clearance rate(97.8%vs.100.0%),and incidence of complication(2.2%vs.0)between two methods in group B(P>0.05).Conclusion Both EST/EPBD+LC and OC+OCHTD are safe and effective for common bile stones and gallbladder stones,but the former has shorter operative time and less intraoperative blood loss than the latter.

关 键 词：胆总管结石 胆囊结石 内镜十二指肠乳头括约肌切开/内镜十二指肠乳头球囊扩张术+腹腔镜胆囊切除术 胆 囊切除+胆总管切开取石T管引流术 

分 类 号：R657.4[医药卫生—外科学]