完全腹腔镜保胆取石术治疗慢性结石性胆囊炎效果评价  

Totally laparoscopic cholecystolithotomy as a treatment for chronic calcular cholecystitis： a case- control study

作　　者：朱任飞[1] 卢潮德[1] 吴建军[1] 肖旭[1] 吴金柱[1] 汪刘华 

机构地区：[1]南通市第三人民医院普外科,南通226001 [2]江苏仪征市人民医院普外科,仪征211400

出　　处：《国际外科学杂志》2016年第7期454-457,共4页International Journal of Surgery

基　　金：基金项目：南通市卫生局青年科研基金（WQ2014037）

摘　　要：目的评估完全腹腔镜保胆取石术的安全性及可行性。方法选取南通市第一人民医院34例完全腹腔镜保胆取石术患者（保胆组）及同期34例腹腔镜胆囊切除术患者（切胆组），进行对比分析，并进行术后随访。结果手术时间在保胆组明显延长（124．56minvs78．50min，P〈0．01）；平均住院费用在保胆组明显增加（10970．85元vs8666．72元，P〈0．01）；保胆组术后发生腹泻或腹胀的患者例数少于切胆组，但结果差异无统计学意义（2例vs6例，P=0．26）；术中情况及术后随访结果，包括术中出m量、术后住院时间、术后月T门排气时间、术后腹腔内出血例数、术后胆漏例数及术后切口感染例数差异无统计学意义；在随访过程中，保胆组有l例患者结石复发，在切胆组未出现再患胆总管结石患者。结论完全腹腔镜保胆取石术治疗慢性结石性胆囊炎是安全有效的，尤其适合有医疗保险的患者。然而，这种治疗方式有一定的技术要求，并且实施手术的外科医师需要有一定的经验。Objective To evaluate the safety and feasibility of totally laparoscopic cholecystolithotomy. Methods Patient baseline characteristics of all 34 totally laparoscopic cholecystolithotomy （TLC） were collected in a database. This group was compared with 34 matched patients who underwent the laparoscopic cholecystectomy （LC） in the same period. Retrospectively, intraoperative and postoperative data were added. Results Operating- time was significantly longer in the TLC group（ 124.56 min vs 78.50 min, P 〈0.01 ）. The mean hospitalization ex- penses of operation was significantly higher in the TLC group（ 10 970.85 yuan vs 8 666.72 yuan, P 〈 0.01 ）. Al- though not significant less patients have the symptoms of postoperative dyspepsia or diarrhea were seen in the TLC group compared with the LC group（2 vs 6, P = 0.26）. Intraoperative details and postoperative re^lts such as, blood loss, hospital stay, exhaust time, abdominal bleeding, bile leakage, incision infection have no significant difference. One case of gallstone recurrence was detected in TLC group. No stone recurrence was reported in com- mon bile duct in LC group. Conclusions TLC is effective and feasible for chronic calcular cholecystitis and is par- ticularly favorable for thepatients with medical insurance. However, this approach is technically demanding and should be performed by experienced surgon.

关 键 词：慢性结石性胆囊炎 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]