腹腔镜与开放胆肠内引流术治疗反流性胆管炎疗效对比分析  

Comparative analysis on clinical effects of laparoscopic biliary-anterric drainage with open surgery for reflux cholangitis

作　　者：刘毅[1] 尹新民[1] 周卫[1] 吴一飞[1] 李云峰[1] 何翔宇 廖春红[1] LIU Yi;YIN Xin-min;ZHOU Wei(Department of Hepatobiliary Minimally Invasive Surgery,the People's Hospital of Hunan Province,Changsha410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)肝胆微创外科,湖南长沙410005

出　　处：《中国实用外科杂志》2021年第7期791-794,共4页Chinese Journal of Practical Surgery

基　　金：湖南省自然科学基金(No.2018JJ6015);湖南省肝胆胰肠诊疗能力提升项目(No.湘卫[2019]118号)。

摘　　要：目的比较分析腹腔镜与开放胆肠内引流术治疗反流性胆管炎的临床疗效。方法回顾性分析2016年1月至2019年12月湖南省人民医院收治的行手术治疗的122例反流性胆管炎病人的临床资料。根据手术方式分为腹腔镜手术(腹腔镜组,59例)和开放手术(开放组,63例)。比较两组手术时间、失血量、术后并发症、住院时间、术后肛门排气时间等疗效相关指标。结果腹腔镜组与开放组病人手术时间差异无统计学意义[(264.5±59.4)min vs.(236.1±64.3)min,P=0.247],而在术中出血量[(61.0±15.2)mL vs.(185.2±35.1)mL,P=0.032]、术后肛门排气时间[(2.6±0.8)d vs.(4.0±1.2)d,P<0.01]、住院时间[(8.2±2.8)d vs.(11.5±3.8)d,P=0.015]差异有统计学意义。无死亡病例及非计划再手术,腹腔镜组无中转手术病例。腹腔镜组发生胆瘘8例,术后消化道出血3例;开放组发生胆瘘5例,消化道出血4例,两组间并发症发生率比较差异无统计学意义(P>0.05),均经保守治疗后好转。随访12~48个月,所有病例症状消失且无复发。结论腹腔镜胆肠内引流术治疗反流性胆管炎具有术中出血少,术后肛门排气时间、住院时间短,恢复快等优点,疗效确切,且未增加并发症。Objective To investigate the therapeutic effect of laparoscopic or open choledochojejunostomy for reflux cholangitis.Methods From January 2016 to December 2019,the clinical data of 122 patients who underwent surgical treatment for reflux cholangitis were collected and analyzed retrospectively.The patients were divided into the laparoscopic surgery(laparoscopic group,59 cases)and open surgery(open group,63 cases)based on the operation received.The clinical data including operation time,blood lose,postoperative complications,postoperative hospital stay,anus exhausting time were compared between two groups.Results The mean operation time of the open group was less than laparoscopic group[(264.5±59.4)min vs.(236.1±64.3)min,P=0.247].There was no statistical significance in the difference.The laparoscopic group showed advantage trends over the open group in blood lose[(61.0±15.2)mL vs.(185.2±35.1)mL,P=0.032],anus exhausting time[(2.6±0.8)d vs.(4.0±1.2)d,P<0.01],postoperative hospital stay[(8.2±2.8)d vs.(11.5±3.8)d,P=0.015].There was no death case and unplanned reoperation case,no patient in laparoscopic group converted to open.Among the laparoscopic group,there were 8 cases of bile leakage and 3 cases of postoperative biliary bleeding.In the open group,there were 5 cases of biliary leakage,4 cases of biliary tract bleeding.There was no significant difference in the incidence of complications between the two groups(P>0.05).All patients with postoperative complications were cured after conservative treatment.During follow-up visit of 12 to 48 months,all cases of symptoms disappeared with no recurrence.Conclusion Laparoscopic biliary-anterric drainage in the treatment of reflux cholangitis has the advantages of less intraoperative bleeding,shorter postoperative anal exhaust time,shorter hospital stay,and faster recovery.It has definite curative effect,and does not increase complications.

关 键 词：腹腔镜 胆肠内引流术 反流性胆管炎 

分 类 号：R66[医药卫生—外科学]