LTCBDE手术治疗继发性肝外胆管结石的临床效果  

Clinical effects of laparoscopic common bile duct exploration vs laparoscopic common bile duct exploration plus T-tube drainage in treatment of secondary extrahepatic bile duct stones

作　　者：程利民[1] 刘洋[1] 孙志德[1] 刘淑敏[1] 张学军[1] 

机构地区：[1]承德医学院附属医院肝胆外科,河北省承德市067000

出　　处：《世界华人消化杂志》2015年第28期4574-4578,共5页World Chinese Journal of Digestology

摘　　要：目的:分析并比较腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流术治疗继发性肝外胆管结石的临床效果.方法:选取2012-01/2014-06承德医学院附属医院收治的90例继发性肝外胆管结石患者,根据不同的手术方式将其分为观察组以及对照组,每组45例,其中观察组给予LTCBDE治疗,对照组给予腹腔镜胆道探查"T"管引流术(laparoscopic common bile duct exploration,LCBDE),比较两组患者的手术时间、术中出血量、住院费用、以及术后并发症情况.结果:观察组的手术时间明显长于对照组,但其术中出血量、术后住院时间、住院费用、术后补液量以及术后带管时间明显少于对照组,观察组中术后近期并发症的发生率为2.22%(1/45),远期并发症发生率为0,对照组分别为13.33%(6/45)及11.11%(5/45),组间比较有统计学差异(?2=7.349、5.281,P<0.05).结论:只要掌握好手术适应证,LTCBDE具有微创、并发症少、术后恢复快的特点,值得临床推广应用.AIM：To compare the clinical effects of laparoscopic transcyctic common bile duct exploration（LTCBDE） and laparoscopic common bile duct exploration（LCBDE） plus T-tube drainage in the treatment of extrahepatic bile duct stones.METHODS：Ninety patients with secondary extrahepatic bile duct stones treated from January 2012 to June 2014 at our hospital were divided into either an observation group or a control group,with 45 cases in each group.The observation group received LTCBDE,and the control group received LCBDE plus T-tube drainage.Operative time,intraoperative blood loss,hospitalization expenses,and postoperative complications were compared between the two groups.RESULTS：The operative time was significantly longer in the observation group than in the control group,but intraoperative blood loss,postoperative hospital stay,postoperative rehydration,postoperative hospitalization expenses,and time to tube removal were significantly lower in the observation group than in the control group.The incidence rates of early and late complications were significantly lower in the observation group than in the control group（2.22%vs 13.33%,0vs 11.11%,χ~2=7.349 and 5.281,respectively,P〈0.05）.CONCLUSION：As long as the surgical indications are properly selected,LTCBDE is minimally invasive and associated with less complications and faster postoperative recovery than LCBDE plus T-tube drainage in the treatment of secondary extrahepatic bile duct stones.

关 键 词：腹腔镜 胆囊管 胆总管结石 “T管”引流 

分 类 号：R657.4[医药卫生—外科学]