腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床效果研究  

Clinical Effect of Laparoscopic Biliary Tract Exploration in the Treatment of Cholecystolithiasis and Choledocholithiasis

作　　者：曹健[1] 赵新华[1] 熊少敏[1] CAO Jian;ZHAO Xinhua;XIONG Shaomin(Jiujiang First People’s Hospital,Jiujiang 332000,China)

机构地区：[1]江西省九江市第一人民医院,江西九江332000

出　　处：《中国医学创新》2018年第34期38-41,共4页Medical Innovation of China

摘　　要：目的:探讨腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床效果。方法:选取本院2016年5月-2018年5月期间收治的胆囊结石合并胆总管结石患者60例作为研究对象,按照随机数字表法将其分为对照组和观察组,各30例。对照组采用常规开腹胆囊切除及胆总管切开取石术,观察组采用腹腔镜联合胆道探查取石术,比较两组手术效果、手术前后肝功能指标变化、手术成功及不良反应发生情况。结果:两组手术时间比较,差异无统计学意义(P>0.05)。观察组术中出血量、肛门排气及住院时间均明显少于对照组,差异均有统计学意义(P<0.05)。手术前两组谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBIL)水平比较,差异均无统计学意义(P>0.05);手术4周后,两组ALT、AST及TBIL水平与手术前比较均明显升高,但观察组均明显优于对照组,差异均有统计学意义(P<0.05)。两组均未出现明显不良反应,观察组手术成功率为93.33%(28/30),对照组为86.67%(26/30),两组手术成功情况比较,差异无统计学意义(x^2=0.741,P=0.389)。结论:腹腔镜联合胆道探查取石术治疗胆囊结石合并胆总管结石,可明显减少患者术中出血量,加速胃肠功能恢复,缩短住院时间,且对患者肝脏功能影响小,临床疗效满意,值得应用推广。Objective:To investigate the clinical effect of laparoscopic biliary tract exploration in the treatment of cholecystolithiasis with choledocholithiasis.Method:A total of 60 patients with cholecystolithiasis complicated with choledocholithiasis admitted in our hospital from May 2016 to May 2018 were selected as the research objects.According to the random number table method,they were divided into control group and observation group,30 cases in each group. The control group was treated with routine open cholecystectomy andcholedocholithotomy,the observation group was treated with laparoscopy combined with biliary tract exploration.The effect of operation,changes of liver function indexes before and after operation,success of operation and occurrence of adverse reactions between the two groups were compared.Result:There was no significant difference in operative time between the two groups(P>0.05).The amount of intraoperative blood,anal exhaust and hospitalization time in the observation group were significantly less than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in ALT,AST and TBIL levels between the two groups before operation(P>0.05);after operation four weeks,the levels of ALT,AST and TBIL in the two groups were significantly higher than those before operation,but the observation group were significantly better than those in the control group,the differences were statistically significant(P<0.05).There were no obvious adverse reactions in the two groups.The success rate of operation in the observation group was 93.33%(28/30) and that in the control group was 86.67%(26/30).There was no significant difference in the success rate between the two groups( x^2=0.741,P=0.389).Conclusion:Laparoscopy combined with biliary tract exploration in the treatment of cholecystolithiasis with choledocholithiasis can significantly reduce the amount of intraoperative blood,accelerate the recovery of gastrointestinal function,shorten hospitalization time

关 键 词：腹腔镜 胆道探查术 胆囊结石 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]