腹腔镜胆囊切除术对胆囊结石患者术中相关指标和术后胆道感染发生的影响研究  

Effect of laparoscopic cholecystectomy on postoperative cholecystolithiasis and postoperative biliary tract infection in patients with gallstone

作　　者：白正忠 连凌云[1] 廖重五[3] BAI Zhengzhong;LIAN Lingyun;LIAO Chongwu.(The First Hospital of Yulin City in Shaanxi Province (Yulin 719100))

机构地区：[1]陕西省榆林市第一医院,榆林719100 [2]陕西省榆林市横山区人民医院,榆林719199 [3]西安市中心医院普外一科,西安710004

出　　处：《陕西医学杂志》2019年第10期1349-1351,共3页Shaanxi Medical Journal

基　　金：陕西省科技计划攻关项目(2018SF163)

摘　　要：目的:分析腹腔镜胆囊切除术对胆囊结石患者术中相关指标和术后胆道感染发生的影响。方法:随机选取90例胆囊结石患者作为研究对象,按照入院的先后顺序分别采用腹腔镜胆囊切除术(研究组)和胆道镜取石术(对照组)各45例,比较两组术中出血量、手术时间、住院时间及术后胆道感染发生率。结果:研究组患者术中出血量较对照组明显增多(P<0.01),手术时间、住院时间较对照组明显延长(P<0.01)。研究组患者出现术后胆道感染0例,对照组患者出现术后胆道感染6例(6/45,13.33%),两组间比较具有统计学差异(P<0.05),其中检出病原菌中大肠埃希菌和粪肠链球菌分别占83.33%(5/6)、16.67%(1/6),而大肠埃希菌对甲氧苄啶/磺胺甲噁唑的耐药性可高达78.85%,粪肠链球菌对万古霉素的耐药性可低至0.00%。结论:相对腹腔镜保胆取石术,腹腔镜胆囊切除术的手术时间、住院时间较长,术中出血量也较高,但是其术后胆道感染的发生率更低,更有利于促进患者术后康复。Objective:To analyze the influence of laparoscopic cholecystectomy on postoperative cholecystolithiasis and postoperative biliary tract infection.Methods:90 cases of cholecystolithiasis were randomly selected as the subjects.According to the order of admission,laparoscopic cholecystectomy(Study Group)and choledochoscopy(control group)were used in 45 cases respectively.The amount of bleeding,operation time,time of hospitalization and postoperative period were compared between the two groups.The incidence of biliary tract infection.Results:The amount of bleeding in the study group was significantly increased in comparison of the control group(P<0.01),and the operative time and length of stay were significantly longer than those in the control group(P<0.01).The patients in the study group had postoperative biliary tract infection in 0 cases,and 6 cases of postoperative biliary tract infection(6/45,13.33%)in the control group,and the comparison between the two groups suggested that the patients had the biliary tract infection(6/45,13.33%).There were significant differences(P<0.05),among which Escherichia coli and Streptococcus faecal Streptococcus were 83.33%(5/6)and 16.67%(1/6)respectively.The resistance of Escherichia coli to trimethoprim/sulfamethoxazole could be as high as 78.85%,and the drug resistance of Streptococcus faecalis to vancomycin could be as low as 0.00%.Conclusion:Compared with laparoscopic cholecystolithiectomy,laparoscopic cholecystectomy has a long time of operation,long hospital stay and high amount of bleeding,but the incidence of postoperative biliary tract infection is lower,which is more conducive to the recovery of postoperative patients.

关 键 词：胆囊结石 腹腔镜胆囊切除术 胆道取石 保胆取石 胆道感染 对比研究 

分 类 号：R657.4[医药卫生—外科学]