胆道镜联合腹腔镜胆总管探查取石术对有上腹部手术史患者术后康复效果的影响  

Influence of Choledochoscopy Combined with Laparoscopic Common Bile Duct Exploration and Lithotripsy on Postoperative Rehabilitation in Patients with History of Upper Abdominal Surgery

作　　者：郑志铭 ZHENG Zhiming(The Second Hospital of Sanming City,Yong’an 366000,China)

机构地区：[1]三明市第二医院,福建永安366000

出　　处：《中外医学研究》2022年第27期142-146,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:观察胆道镜联合腹腔镜胆总管探查取石术对有上腹部手术史的患者术后康复效果的影响。方法:回顾性分析2016年4月-2021年11月三明市第二医院有上腹部手术史患者72例,依据手术方法分为联合手术组(胆道镜联合腹腔镜胆总管探查取石术,n=26)、开放手术组(开腹胆总管探查取石术,n=46),另选取同期本院无上腹部手术史初次行联合手术患者76例作为初次手术组,统计分析三组疼痛程度、围手术期指标、术后并发症发生情况、复发情况、满意度。比较初次手术组和联合手术组中转开腹情况。结果:手术后,初次手术组与联合手术组的VAS评分比较,差异无统计学意义(P>0.05),开放手术组VAS评分高于初次手术组与联合手术组(P<0.05)。初次手术组、联合手术组的手术时间均短于开放手术组(P<0.05),术中出血量均少于开放手术组(P<0.05),初次手术组的手术时间短于联合手术组(P<0.05),术中出血量少于联合手术组(P<0.05);三组术后腹腔引流量比较,差异无统计学意义(P>0.05);初次手术组、联合手术组的住院时间均短于开放手术组(P<0.05),初次手术组、联合手术组的住院时间比较,差异无统计学意义(P>0.05)。初次手术组的中转开腹率为1.32%(1/76),低于联合手术组的11.54%(3/26)(P<0.05)。初次手术组、联合手术组、开放手术组的并发症总发生率分别是2.63%(2/76)、11.54%(3/26)、17.39%(8/46),差异有统计学意义(P<0.05)。初次手术组、联合手术组、开放手术组的复发率分别为1.32%(1/76)、7.69%(2/26)、8.70%(4/46),差异无统计学意义(P>0.05)。初次手术组、联合手术组、开放手术组的满意度分别是97.37%(74/76)、92.31%(24/26)、86.96%(40/46),差异有统计学意义(P<0.05)。结论:胆道镜联合腹腔镜胆总管探查取石术较开放手术更能促进有上腹部手术史的患者的术后康复。Objective:To observe the effect of choledochoscopy combined with laparoscopic common bile duct exploration and lithotripsy on postoperative rehabilitation in patients with a history of upper abdominal surgery.Method:A total of 72 patients with a history of upper abdominal surgery in the Second Hospital of Sanming City from April 2016 to November 2021 were retrospectively analyzed.According to the surgical method,they were divided into the combined surgery group (choledochoscopy combined with laparoscopic common bile duct exploration and lithotomy,n=26) and the open surgery group (open common bile duct exploration and lithotripsy,n=46).In addition,a total of 76 patients with no history of epigastric surgery in our hospital who underwent combined surgery for the first time during the same period were retrospectively selected as the primary surgery group.The degree of pain,perioperative indicators,postoperative complications,recurrence and satisfaction of the three groups were statistically analyzed.The conversion rate to laparotomy of the primary surgery group and the combined surgery group were compared.Result:After surgery,there was no significant difference in the VAS score between the primary surgery group and the combined surgery group (P>0.05).The postoperative VAS score of the open surgery group was higher than that of the primary surgery group and the combined surgery group (P<0.05).The operation time in the primary surgery group and the combined surgery group was shorter than that in the open surgery group (P<0.05),and the intraoperative blood loss was less than that in the open operation group (P<0.05).The operation time in the primary surgery group was shorter than that in the combined surgery group (P<0.05),the intraoperative blood loss was less than that in the combined surgery group (P<0.05),but there was no significant difference in postoperative abdominal drainage between the three groups (P>0.05).The hospitalization time in the primary surgery group and the combined surgery group was shorter than t

关 键 词：上腹部手术史 胆道镜 腹腔镜 胆总管探查取石术 开放手术 术后康复效果 

分 类 号：R657.4[医药卫生—外科学]