两种胆道探查术式对复发性肝外胆管结石患者围手术期临床指标及并发症的影响  

Influence of two kinds of biliary exploration on perioperative clinical indexes and complications of patients with recurrent extrahepaticbile duct stones

作　　者：张运歆[1] 汪宏[1] 刘玉海[1] ZHANG Yun-xin;WANG Hong;LI U Yu-hai(Binhu Hospital,Hefei First People's Hospital,Hefei 2300001 China)

机构地区：[1]合肥市第一人民医院滨湖医院,合肥230000

出　　处：《肝胆外科杂志》2019年第5期361-364,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨开腹和腹腔镜下小切口胆道探查术对复发性肝外胆管结石患者围手术期临床指标及术后并发症的影响.方法回顾性分析我院2013年6月~2018年10月收治复发性肝外胆管结石患者共82例,其中42例采用开腹胆道探查术治疗设为对照组,40例采用腹腔镜下小切口胆道探查术治疗设为观察围手术期临床指标、并发症发生率及术后肝功能指标水平.结果观察组腹腔粘连分离时间、术中失血量、术后首次肛门时间、术后住院时间及术后镇痛率均显著低于对照组(P<0.05);两组胆道探查时间和住院费用比较差异无显著性(P>0.05);观察组术中肠道损伤和切口感染发生率均显著低于对照组(P<0.05);两组术后胆漏和肺部感染发生率比较差异无显著性(P>0.05);同时两组术后肝功能指标水平比较差异无显著性(P>0.05).结论腹腔镜下小切口胆道探查术用于复发性肝外胆管结石患者能够可缩短操作用时,降低手术损伤程度,加快术后康复,并有助于预防术中肠道损伤和切口感染发生,价值优于开腹胆道探查术.Objective To investigate the influence of open and laparoscopic mini-incision biliary exploration on perioperative clinical indexes and complications of patients with recurrent extrahepatic bile duct stones.Methods 82 patients with recurrent extrahepatic bile duct stones were chosen in the period from June 2013 to October 2018 in our hospital and divided into both groups including control group(42 patients)with open biliary exploration and observation group(40 patients)with laparoscopic mini-incision biliary exploration;and the levels of perioperative clinical indicators,complications incidence and the levels of post-operative liver function of both groups were compared.Results The separation time of abdominal adhesions,intraoperative blood loss volume,first anal time after operation,hospital staying time after operation and postoperative analgesia rate of observation group were significantly less than control group(P<0.05).There was no significant difference in the biliary exploration time and hospitalization expenses between 2 groups(P>0.05).The incidence of intestinal injury in operation and incision infection of observation group were significantly lower than control group(P<0.05).There was no significant difference in the incidence of biliary leakage and pulmonary infection after operation between 2 groups(P>0.05).There was no significant difference in the levels of post-operative liver function between 2 groups(P>0.05).Conclusion Compared with open biliary exploration,laparoscopic mini-incision biliary exploration in the treatment of patients with recurrent extrahepatic bile duct stones can efficiently shorten the operation time,reduce the surgical injury degree,accelerate the recovery process after operation and be helpful to prevent intestinal injury in operation and incision infection.

关 键 词：开腹 腹腔镜 小切口 胆道探查术 复发性肝外胆管结石 

分 类 号：R657.4[医药卫生—外科学]