两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析  

A comparative study of LCBDE and LBEPS in the treatment of choledocholithiasis with≥1.0 cm common bile duct diameter

作　　者：练远书 黄高 陆开艺 文明波 Lian Yuanshu;Huang Gao;Lu Kaiyi;Wen Mingbo(Hepatobiliary and Pancreatic Surgery,924 Hospital of Joint Logistics Support Force of PLA,Guilin 541002,Chian)

机构地区：[1]解放军联勤保障部队第九二四医院肝胆胰外科,桂林541002

出　　处：《中华普外科手术学杂志（电子版）》2020年第5期530-533,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探究腹腔镜胆总管切开探查取石并T管外引流术(LCBDE)与腹腔镜胆总管切开探查取石并一期缝合术(LBEPS)对胆总管直径≥1.0 cm结石患者的治疗效果。方法回顾性分析2015年1月至2019年1月胆总管直径≥1.0 cm结石患者100例资料,按不同术式分为LCBDE组52例、LBEPS组48例。采用SPSS20.0统计软件进行分析处理。术中术后各项指标、胆管压力、生活质量、应激反应比较采用(±s)描述,独立样本t检验;术后并发症、取石成功率、结石残余率、复发率比较采用χ2检验,P<0.05为具有统计学意义。结果LBEPS组患者引流时间、下床活动时间、可进食时间、胃肠道功能恢复时间、住院时间均少于LCBDE组(P<0.05)。术后LBEPS组患者生活质量评分高于LCBDE组,胆管压力低于LCBDE组(P<0.05)。LBEPS组患者术后应激反应程度低于LCBDE组(P<0.05)。LCBDS组患者取石成功率高于LCBDE组,结石残余率、复发率均低于LBEPE组,但两组比较差异无统计学意义(P>0.05)。LBEPS组患者术后并发症发生率为3.9%(2/52)低于LCBDE组18.8%(9/48),P<0.05。结论LBEPS治疗胆总管直径≥1.0cm结石可促进患者术后快速恢复,减少患者手术机体应激反应,取石成功率较高,且术后并发症发生率较低,安全性较高。Objective To study the effect of laparoscopic common bile duct exploration with T tube drainage(LCBDE)and laparoscopic common bile duct exploration with primary suture(LBEPS)for the treatment of choledocholithiasis with≥1.0 cm common bile duct diameter.Methods From January 2015 to January 2019,100 patients with calculi of common bile duct diameter≥1.0 cm admitted to our hospital were retrospectively analyzed.According to different operative methods,52 patients were divided into LCBDE group and 48 patients were divided into LBEPS group.SPSS20.0 statistical software was used for analysis.Intraoperative and postoperative indicators,bile duct pressure,quality of life,and stress response were described by(±s),and compared with independent t test.χ2 test was used to compare postoperative complications,success rate of stone extraction,residual stone rate and recurrence rate.P<0.05 was considered statistically significant.Results Patients in the LBEPS group had shorter drainage time,activity time,feeding time,recovery time of gastrointestinal function and hospitalization time than those in the LCBDE group(P<0.05).Postoperative quality of life score in LBEPS group was higher than that in LCBDE group,and bile duct pressure was lower than that of LCBDE group(P<0.05).The degree of postoperative stress response in the LBEPS group was lower than that in the LCBDE group(P<0.05).The success rate of stone extraction in the LCBDS group was higher than that in the LCBDE group,and the residual and recurrence rates of stones were lower than those in the LBEPE group,but there was no statistical difference between the two groups(P>0.05).The incidence of postoperative complications in the LBEPS group was 3.9%(2/52),which was lower than that in the LCBDE group(18.8%(9/48)(P<0.05).Conclusion LBEPS for the treatment of calculi with the diameter of common bile duct≥1.0 cm can promote the rapid recovery of patients after surgery,reduce the stress response of patients during surgery,and achieve a high success rate of stone extraction,

关 键 词：胆总管结石 腹腔镜 腹腔镜胆总管切开探查取石并T管外引流术 腹腔镜胆总管切开探查取石并一期缝合术 疗效比较研究 

分 类 号：R657.4[医药卫生—外科学]