腹腔镜下胆囊管探查胆囊管结石处理86例临床分析  

Clinical analysis of laparoscopic exploration in treating cystic duct calculus,Report of 86 cases

作　　者：张建[1] 陈杰[1] 张新民[1] 

机构地区：[1]天门市第一人民医院普外科,湖北省431700

出　　处：《中华普外科手术学杂志（电子版）》2015年第5期48-50,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下胆囊探查治疗急慢性胆囊炎并存胆囊管结石的处理技巧及疗效。方法回顾性分析2009年3月至2013年3月急慢性胆囊炎合并胆囊管结石86例患者，急性胆囊炎患者48例（急性组），慢性胆囊炎患者38例（慢性组），观察两组疗效。采用SPSS13．0软件进行统计分析，计量数据以（x±s）表示，采用方差分析，计数资料采用卡方检验，P〈0．05为差异有统计学意义。结果84例行腹腔镜胆囊切除，2例行中转开腹胆囊切除。腹腔镜手术成功率为97．6％。全组患者均无出血、胆管损伤、胆道狭窄等并发症。慢性组手术时间为（35±10）min、急诊组手术时间为（55±12）min，两组差异有统计学意义（t=0．014，P〈0．05）。其他在下床活动时间、开始进食时间、引流管留置时间、住院天数、并发症两组差异无统计学意义。随诊12～48个月，均复查超声或CT检查未发现残余结石、胆道狭窄等并发症，未见并发症发生。结论术中仔细探查胆囊管，处理耐心，操作规范，熟练掌握胆囊管挤压、胆囊管壁部分切开等手术技巧，腹腔镜下胆囊管探查治疗胆囊管结石手术时安全可行的。Objective To assess therapeutic experience with laparoscopic exploration in the management of patients with combined acute/chronic cholecystitis and cystic duct calculus. Methods From March 2009 to March 2013, the clinical data of 86 patients with combined acute/chronic cholecystitis and cystic duct were analyzed retrospectively. The patients included 48 patients with acute cholecystitis （acute group） and 38 patients with chronic cholecystitis （chronic group）. Statistical analysis was performed by using SPSS13.0 software, whereas measurement data were expressed as mean ± SD and examined by variance analysis. Count data were examined by the Cbi-square test, P 〈 0.05 was considered statistically significant. Results The 84 patients underwent laparoscopic cholecystectomy, including 2 patients with conversion to open cholecystectomy. The success rate of laparoscopic operation was 97. 6%. There were serious complications such as postoperative bleeding, bile duct injury, and bile duct stenosis. Operation time in the chronic group was （35 ±10） minutes, but （55 ±12） minutes in the emergency group （t = 0. 014, P 〈 0.05 ）. There was no significant difference in ambulation time, time of first feeding, duration of drainage, hospital stay and complications between the two groups. In a follow-up of 12 -48 months, ultrasound or CT examination showed neither residual stones nor complications such as biliary stricture. Conclusions Laparoscopic exploration is safe and feasible for the management of patients with combined acute/chronic cholecystitis and cystic duct calculus.

关 键 词：胆囊炎 胆囊结石病 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]