腹腔镜辅助胆管镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的疗效比较  

A comparative study of laparoscopic-assisted choledochoscopic cholelithotripsy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis

作　　者：陈建华 陈文亮[2] Chen Jianhua;Chen Wenliang(Department of General Surgery,the People's Hospital of Yuci District,Jinzhong,Shanxi 030600,China;Department of General Surgery,the Second Affiliated Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西省,晋中市榆次区人民医院普外科,030600 [2]山西医科大学附属第二医院普外科,太原030001

出　　处：《中国基层医药》2020年第3期339-343,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山西省卫生计生委科研课题计划项目(2017261)。

摘　　要：目的比较腹腔镜辅助胆管镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石患者的疗效。方法回顾性分析2013年3月至2018年3月晋中市榆次区人民医院收治的胆囊结石患者81例的临床资料。根据手术方式的不同将患者分为对照组(n=38,腹腔镜胆囊切除术)和研究组(n=43,腹腔镜辅助胆管镜保胆取石术),比较两组患者围术期指标、肝功能指标、术后复发率及并发症发生率。结果研究组手术时间、住院时间、胃肠功能恢复时间、术后恢复饮食时间、术中出血量分别为(43.59±4.59)min、(7.24±1.17)d、(15.51±2.09)d、(2.88±0.42)d、(15.07±1.32)mL,均优于对照组的(55.23±5.47)min、(9.12±1.32)d、(26.48±3.48)d、(3.53±0.58)d、(24.65±1.48)mL(t=10.411、6.796、17.426、5.823、6.864,均P=0.000);研究组术后1 d的总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转氨酶(AST)、总蛋白(TP)水平分别为(24.39±2.21)μmol/L、(29.09±4.68)U/L、(29.02±4.41)U/L、(21.95±2.52)g/L,均低于对照组的(28.43±2.31)μmol/L、(34.39±4.28)U/L、(35.31±3.08)U/L、(25.28±2.42)g/L(t=8.038、5.293、7.348、6.046,均P=0.000);研究组术后3 d的TBIL、ALT、AST、TP水平分别为(20.32±2.24)μmol/L、(24.61±4.26)U/L、(23.68±4.79)U/L、(18.94±2.89)g/L,均低于对照组的(24.45±2.02)μmol/L、(29.81±3.32)U/L、(27.94±4.50)U/L、(21.41±2.87)g/L(t=8.669、6.609、4.109、3.851,均P=0.000);对照组、研究组的复发率分别为5.26%(2/38)、6.98%(3/43),组间差异无统计学意义(χ2=0.102,P=0.749);研究组的并发症发生率为4.65%(2/43),低于对照组的21.05%(8/38),差异有统计学意义(χ2=5.015,P=0.025)。结论与腹腔镜胆囊切除术相比,腹腔镜辅助胆管镜保胆取石术疗效更优,可减少对肝功能的损害,并发症发生率低。Objective To compare the efficacy of laparoscopic choledochoscopic cholelithotripsy and laparoscopic cholecystectomy in the treatment of cholecystolithiasis.Methods A retrospective study was conducted in 81 cases of cholecystolithiasis who admitted to the People's Hospital of Yuci District from March 2013 to March 2018.The patients were divided into control group(n=38,laparoscopic cholecystectomy)and study group(n=43,laparoscopic choledochoscope choledocholithotomy)according to the different surgical method.The perioperative indicators,liver function indicators,recurrence rate and complications were compared between the two groups.Results The operation time,hospital stay,recovery time of gastrointestinal function,recovery time of diet after operation and intraoperative bleeding volume in the study group were(43.59±4.59)min,(7.24±1.17)d,(15.51±2.09)d,(2.88±0.42)d,(15.07±1.32)mL,respectively,which were better than those in the control group[(55.23±5.47)min,(9.12±1.32)d,(26.48±3.48)d,(3.53±0.58)d,(24.65±1.48)mL](t=10.411,6.796,17.426,5.823,6.864,all P=0.000).The levels of total bilirubin(TBIL),alanine transferase(ALT),aspartate aminotransferase(AST)and total protein(TP)at 1 day after operation in the study group were(24.39±2.21)μmol/L,(29.09±4.68)U/L,(29.02±4.41)U/L,(21.95±2.52)g/L,respectively,which were lower than those in the control group[(28.43±2.31)μmol/L,(34.39±4.28)U/L,(35.31±3.08)U/L,(25.28±2.42)g/L](t=8.038,5.293,7.348,6.046,all P=0.000).TBIL,ALT,ALT,AST,AST,TP levels at 3 days after surgery in the study group were(20.32±2.24)μmol/L,(24.61±4.26)U/L,(23.68±4.79)U/L,(18.94±2.89)g/L,respectively,which were lower than those in the control group[(24.45±2.02)μmol/L,(29.81±3.32)U/L,(27.94±4.50)U/L,(21.41±2.87)g/L](t=8.669,6.609,4.109,3.851;all P=0.000).The recurrence rates of the control group and the study group were 5.26%(2/38)and 6.98%(3/43),respectively,there was no statistically significant difference between the two groups(χ2=0.102,P=0.749).The incidence of complications in th

关 键 词：胆囊结石病 胆囊切除术 腹腔镜 腹腔镜辅助胆管镜保胆取石术 手术后并发症 胆红素 天冬氨酸氨基转移酶类 复发率 

分 类 号：R657[医药卫生—外科学]