腹腔镜胆道探查术对胆囊结石合并胆总管结石的疗效及安全性评价  

The efficacy and safety of laparoscopic bile duct exploration for patients with both cholecystolithiasis and choledocholithiasis

作　　者：李敏献 邢人伟[1] 鲁葆春[2] 

机构地区：[1]浙江省台州市立医院普外科,浙江台州318000 [2]浙江省绍兴市人民医院普外科,浙江绍兴312000

出　　处：《中国现代医生》2014年第32期139-141,144,共4页China Modern Doctor

基　　金：浙江省卫生厅;省医学会临床科研基金项目(2012ZYC-A73)

摘　　要：目的探讨腹腔镜胆道探查术在胆囊结石合并胆总管结石治疗中的临床疗效及安全性。方法 148例胆囊结石合并胆总管结石患者分别行胆囊管胆道探查术(胆囊管组,26例)、胆管切开胆道探查并胆总管一期缝合(一期缝合组,65例)和胆管切开胆道探查并胆总管T管引流术(T管引流组,57例),比较三组患者的手术情况、术后恢复情况及并发症发生情况。结果三组患者的手术时间(F=36.789,P<0.01)、术中出血量(F=13.467,P<0.01)、胃肠功能恢复时间(F=29.615,P<0.01)、住院天数(F=39.610,P<0.01)有显著差异;一期缝合组的手术时间(t=5.76,P<0.01)、术中出血量(t=4.71,P<0.01)、胃肠功能恢复时间(t=6.78,P<0.01)、住院天数(t=9.94,P<0.01)均小于T管引流组;住院费用高于T管引流组(t=15.78,P<0.01)。结论经胆囊管途径的腹腔镜胆道探查术的临床疗效优于腹腔镜下胆管切开后一期缝合和T管引流术。Objective To assess the clinical efficacy and operation safety of laparoscopic bile duct exploration for patients with both cholecystolithiasis and choledocholithiasis. Methods A total of 148 patients with both cholecystolithiasis and choledocholithiasis were respectively performed the transcytic common bile duct exploration with choledochoscope （TCBDE） （TCBDE group, 26 cases）, primary duct closure group （65 cases） and T-tube drainage （T-tube group, 57 cases）, the operation situation, postoperative recovery and complications were observed among three groups. Results The operative time （F=36.789, P〈0.01）, blood loss （F=13.467, P〈0.01）, gastrointestinal function recovery time （F=29.615, P〈0.01）, hospital stay （F=39.610, P〈0.01） of three group had significant difference; the operative time （t=5.76, P〈0.01）, blood loss （t=4.71, P〈0.01）, gastrointestinal function recovery time （t=6.78, P〈0.01）, hospital stay （t=9.94, P〈0.01） of the primary duct closure group were less than the T-tube group; hospitalization costs were higher than T-tube drainage group （t=15.78, P〈0.01）. Conclusion The clinical efficacy of transcytic common bile duct exploration with choledochoscope in patients with both cholecystolithiasis and choledocholithiasis is superior to the primary duct closure and T-tube drainage after laparoscopic choledochotomy.

关 键 词：腹腔镜胆道探查术 胆囊结石 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]