继发性肝外胆管结石患者腹腔镜下经胆囊管胆总管探查取石术的疗效  

Analysis of clinical efficacy of LTCBDE in patients with secondary extrahepatic bile duct stones

作　　者：韩明明[1] 张宝[1] 杨壮杰 赵伟[1] 窦春青[1] 朱自满[1] 王大东[1] 

机构地区：[1]北京解放军总医院第一附属医院肝胆胰脾外科,100048

出　　处：《实用医学杂志》2016年第12期1991-1993,共3页The Journal of Practical Medicine

基　　金：北京市科技立项(编号:Z151100003915155)

摘　　要：目的:探讨腹腔镜下经胆囊管胆总管探查取石术(LTCBDE)手术治疗继发性肝外胆管结石患者病情的疗效。方法:选择我院收治的继发性肝外胆管结石患者87例,随机分为腹腔镜下胆道探查"T"管引流术(LCBDE)治疗组(对照组)和腹腔镜下经胆囊管胆总管探查取石术(LTCBDE)治疗组,统计两组的手术时间、手术出血量、术后补液量、术后引流时间、术后住院时间、住院费用、术后恢复时间、相关并发症等,比较临床疗效。结果:LTCBDE组患者手术时间大于对照组(2.1±0.5)d vs.(1.6±0.4)d,P<0.001],LTCBDE组手术出血量、术后补液量、术后引流时间、术后住院时间、住院费用、术后恢复时间分别为(17.4±5.4)m L、(6 550.4±1 076.9)m L、(3.5±1.6)d、(4.1±1.7)d、(12 243.5±2 379.6)元、(11.3±3.5)d均小于LCBDE组的(22.1±7.5)m L、(8 304.2±1 394.8)m L、(32.9±10.4)d、(6.4±2.4)d、(14 098.1±2 897.3)元、(16.1±5.7)d(P值分别为0.001、0.000、0.000、0.015、0.001、0.000);LTCBDE组患者发生胆漏、急性腹膜炎的比例分别为1/46、1/46,均小于LCBDE组的6/41、7/41(P值分别为0.033、0.016)。结论:在一定的适应证情况下,LTCBD手术治疗具有损伤小、花费少、并发症少等优点,对继发性肝外胆管结石患者的病情改善具有重要意义。Objective To investigate the effect of laparoscopic cholecystectomy （LTCBDE） in treatment of patients with secondary extrahepatic bile duct stones. Methods Eighty-seven cases of our hospital patients with secondary to extrahepatic bile duct stones were randomly divided into the laparoscopic bile duct exploration and T tube drainage surgery （LCBDE） treatment group and the laparoscopic transcystic duct exploration of common bile duct lithotomy （ltcbde） treatment group. The observation focused on the operation time, bleeding volume , postoperative transfusion , postoperative drainage time , postoperative hospitalization time , cost of hospitalization, postoperative recovery time and complications compared clinical efficacies. Results LTCBDE group of patients in operation time （2.1 ± 0.5） was longer than that of the control group （1.6 ± 0.4）, （P 〈0.001）, while the bleeding volume, postoperative fluid volume, postoperative drainage time, postoperative hospitalization time, hospitalization expenses and postoperative recovery time were （17.4 ± 5.4）, （6 550.4 ± 1 076.9）, （3.5. 1.6）, （4.1 ± 1.7）, （12 243.5 ± 2 379.6）, （11.3 ± 3.5） were lower than that of the group LCBDE （22.1 ± 7.5）, （8 304.2 ± 1 394.8）, （32.9 ± 10.4）, （6.4 ± 2.4）, （14 098.1 ± 2 897.3）, （16.1 ± 5.7） P, respectively （P values were defined as 0.001, 0, 0, 0.015, 0.001, 0 individually）; LTCBDE group of patients with bile leakage, acute peritonitis rates were 1/46,1/46,in which those were lower than the corresponding LCBDE in 6/41, 7/41 （P values were 0.033, 0.016, separately）. Conclusion According to indications, LTCBD surgery has the advantages of less injury, less cost, less complications and so on. It has important significance to improve the condition of patients with secondary extrahepatic bile duct stones.

关 键 词：继发性肝外胆管结石 LTCBD手术 临床疗效 

分 类 号：R657.4[医药卫生—外科学]