飞行人员微创保胆取石术与胆囊切除术远期疗效及对飞行影响的比较研究  

Long-term efficacy of minimally invasive choledocholithotomy and cholecystectomy in aircrew and impact on flight

作　　者：刘承利 蒲猛 王成 马英博 孔亚林 黄峰 何晓军 赵刚 戴竞耀 孔令红 陈江敏 徐先荣 崔丽 王建昌 LIU Chengli;PU Meng;WANG Cheng;MA Yingbo;KONG Yalin;HUANG Feng;HE Xiaojun;ZHAO Gang;DAI Jingyao;KONG Linghong;CHEN Jiangmin;XU Xianrong;CUI Li;WANG Jianchang(Department of Hepatobiliary Surgery,Air Force Medical Center,Beijing 100142,China)

机构地区：[1]空军特色医学中心肝胆外科,北京100142 [2]空军特色医学中心医研部,北京100142 [3]空军特色医学中心航空航天眩晕诊疗研究中心,北京100142 [4]空军特色医学中心睡眠医学科,北京100142

出　　处：《空军航空医学》2022年第5期197-200,共4页AVIATION MEDICINE OF AIR FORCE

基　　金：全军后勤科研重大项目(AKJ15J003)。

摘　　要：目的比较微创保胆取石术与胆囊切除术临床诊治经过及远期效果,为胆囊结石(息肉)飞行人员的术式选择及航空医学鉴定提供依据。方法回顾性分析空军特色医学中心2008年9月—2020年10月收治的31例胆囊结石(息肉)飞行人员临床资料,依据手术方式分为保胆取石组及胆囊切除组。比较2组飞行人员术前症状、结石数目、结石性质、术后远期疗效、生活质量指数评分以及航空医学鉴定结论。结果(1)与胆囊切除组比较,保胆取石组术前右上腹不适者占比低,结石1~3枚者占比高,≥4枚者占比低,胆固醇性结石者占比高,差异有统计学意义(P=0.031、0.025、0.040);保胆取石组术后胆囊结石复发3例,胆囊切除组术后无胆管结石发生;2组术后胃肠道疾病生活质量指数评分差异无统计学意义(P>0.05),但与胆囊切除组比较,保胆取石组主观症状评分高,差异有统计学意义(t=2.42,P=0.022),保胆取石组飞行员术后肠道功能紊乱评分明显高于胆囊切除组,差异有统计学意义(t=2.83,P=0.009);(2)2组飞行人员航空医学鉴定结论均无因胆囊结石术后原因造成停飞。结论依据症状、结石数量、结石性质对胆囊结石(息肉)飞行人员采用腹腔镜微创保胆取石术或胆囊切除术治疗,具有相同疗效,但保胆取石术对飞行的影响可能更小。Objective To compare the clinical process of treatment and long-term effects of minimally invasive cholecystolithotomy and cholecystectomy in pilots,and provide data for selection of approaches to surgery and aviation medical evaluation.Methods The clinical data of 31 pilots with gallstones or gallbladder polyps treated in the Air Force Medical Center between September 2008 and October 2020 were analyzed retrospectively.They were divided into the cholecystolithotomy(polyP)group and cholecystectomy group according to surgical approaches.The preoperative symptoms,number of stones,ingredients of stones,long-term postoperative efficacy,Gastrointestinal Quality of Life Index and results of aviation medical evaluation of the two groups were analyzed.Results(1)Compared with the cholecystectomy group,the proportion of asymptomatic cases,cases with less than 3 stones and those with cholesterol stones in the cholecystolithotomy group was significantly higher(P=0.031、0.025、0.040).There were 3 recurrent cases after cholecystolithotomy.There was no significant difference in the Gastrointestinal Quality of Life Index between the two groups(P>0.05).The subjective symptom score of the cholecystolithotomy group was significantly higher than that of the cholecystectomy group(t=2.42,P=0.022),and the related score of gastrointestinal dysfunction was higher(t=2.83,P=0.009).(2)There was no grounding due the postoperative symptoms.Conclusion Based on the symptoms,numbers of stones and ingredients of stones,laparoscopic cholecystolithotomy and cholecystectomy have the same curative effect,but cholecystolithotomy may have less impact on f light.

关 键 词：腹腔镜 保胆取石术 胆囊切除术 医学鉴定 随访 飞行人员 

分 类 号：R657.4[医药卫生—外科学] R856.6[医药卫生—临床医学]