腹腔镜手术与传统开放手术治疗老年残余胆囊胆管结石的疗效对比  

Efficacy Comparison of Laparoscopic Surgery and Traditional Open Surgery in the Treatment of Elderly Patients with Residual Gallbladder Bile Duct Stones

作　　者：李继东[1] 冯帆[1] 耿天翔 

机构地区：[1]焦作市人民医院普外一区,焦作454000

出　　处：《肝胆外科杂志》2017年第4期278-281,共4页Journal of Hepatobiliary Surgery

摘　　要：目的对比分析腹腔镜手术与传统开放手术治疗老年残余胆囊胆管结石的疗效。方法回顾性选取我院2013年5月至2017年5月期间收治的50例经肝胆超声、上腹部磁共振胰胆道成像(MRCP)检查明确为残余胆囊胆管结石患者的临床资料,根据不同手术治疗方法分为腹腔镜组(n=25)和开放组(n=25),统计两组手术基本情况,术前、术后腹痛、腹胀改善情况及术后胃肠道恢复效果。结果腹腔镜组手术时间明显较开放组短,术中失血量显著低于开放组(P<0.05),结石清除率为100.00%略高于开放组的92.00%,但差异无统计学意义(P>0.05),术后并发症发生率8.00%显著低于开放组的32.00%(P<0.05)。术前两组腹痛、腹胀评分比较无明显差异(P>0.05),术后12h腹痛、腹胀评分均明显降低,与术前相比差异有统计学意义(P<O.05),且腹腔镜组腹痛评分、腹胀评分均明显低于对照组(P<0.05)。腹腔镜组术后肠鸣音恢复时间、肛门排气时间、排便时间及固体食物进食时间均显著较开放组短(P<0.05)。结论与传统开放手术相比,腹腔镜手术治疗老年残余胆囊胆管结石可一定程度降低机体因手术操作、老年患者免疫力低导致的术后并发症,显著缓解腹痛、腹胀症状和促进术后胃肠功能恢复。Objective To compare the efficacy of laparoscopic surgery and conventional open surgery in the treatment of elder- ly patients with residual gallbladder bile duct stones. Methods The clinical data of 50 patients with residual gallbladder bile duct stones diagnosed by hepatobiliary ultrasound and upper abdominal magnetic resonance cholangiopancreatography （MRCP） in our hospi- tal from May 2013 to May 2017 were retrospectively selected and all the patients were divided into the laparoscopic group （n = 25） and the open group （n = 25 ） according to the different surgical methods. The basic situation of operation in two groups, the improvement of abdominal pain and abdominal distension before and after operation, and the effect of postoperative gastrointestinal tract restoration were counted and analyzed between the two groups. Results The operative time of the laparoscopic group was significantly shorter than that of the open group, and the intraoperative blood loss amount was significantly lower than that of the open group （P 〈 0. 05）. The remov- al rate of stone was 100. 00% , which was higher than that of the open group with 92.00%, but the difference was not statistically sig- nificant （P 〉0. 05 ）. The incidence rate of postoperative complications was 8. 00% in the laparoscopic group, which was significantly lower than that of the open group with 32.00% （P 〈 0.05）. There were no significant differences in the scores of abdominal pain and abdominal distention between the two groups （P 〉 0. 05 ） , and the scores of abdominal pain and abdominal distention at 12h after oper- ation were significantly decreased, compared with those before operation difference was statistically significant （ P 〈 0. 05 ）, and the scores of abdominal pain and abdominal distention were significantly lower in the laparoscopic group than those in the control group （P 〈 0. 05）. The postoperative recovery time of bowel sound, anal exhaust time, defecation time and solid intake time were significa

关 键 词：腹腔镜手术 传统开放手术 老年 残余胆囊胆管结石 

分 类 号：R657.434[医药卫生—外科学]