日间手术与次日出院的腹腔镜经胆囊管胆道探查取石术回顾性病例对照研究  

A retrospective case-control study on fast tract laparoscopic transcystic common bill duct exploration:ambulatory surgery versus over-night surgery

作　　者：武亚东 汪栋[1] 徐维宇 周晓娜[1] 郭伟[1] 刘军[1] Wu Yadong;Wang Dong;Xu Weiyu;Zhou Xiaona;Guo Wei;Liu Jun(Department of General Surgery Sub-Center,Beijing Friendship Hospital,Capital Medical University Beijing Key Laboratory of Cancer Invasion and Metastasis Research&National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科分中心、国家消化系统疾病临床医学研究中心,北京100050

出　　处：《国际外科学杂志》2022年第12期825-832,共8页International Journal of Surgery

摘　　要：目的探讨扩大日间腹腔镜下胆道镜经胆囊管胆道探查取石术(LTCBDE)手术适应证的可能性。方法采用回顾性病例对照研究的方法分析首都医科大学附属北京友谊医院自2015年1月—2018年12月行腹腔镜胆囊切除及术中联合胆道镜经胆囊管胆道探查取石术的585例患者的临床病例资料,其中行日间LTCBDE术的患者分为研究组(n=155),次日出院的LTCBDE患者设为对照组(n=430),采用倾向性评分对其相关变量进行匹配,成功匹配到144对,比较两组患者在手术相关指标方面的差异,包括术前化验、最近1个月急性发作病史、上腹部手术史、伴随疾病(高血压、糖尿病、冠心病、脑血管疾病及呼吸系统疾病)、美国麻醉师协会(ASA)评分、术中出血量、手术时间、总医疗费用、非计划再入院率。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用χ^(2)检验,非正态分布的计量资料用M(Q_(1),Q_(3))表示,组间比较采用Fisher精确概率检验及Wilcoxon rank-sum检验。结果研究组在天冬氨酸氨基转氨酶(AST)、丙氨酸氨基转氨酶(ALT)、总胆红素、直接胆红素(DBIL)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、ASA评分、术中出血量、总费用方面的指标分别为21.8(18.0,31.0) U/L、21.5(15.0,42.5) U/L、14.2(11.2,18.6) μmol/L、2.6(2.1,3.5) μmol/L、91.0(73.3,118.5) U/L、44.5(22.0,109.8) U/L、2.0(2.0,2.0)分、7.5(5.0,10.0) mL、9 659.0(8 704.8,10 640.2)元,对照组相应指标分别为26.0(17.7,45.3) U/L、29.5(16.0,85.5) U/L、17.2(13.0,27.5) μmol/L、3.8(2.4,8.7) μmol/L、105.0(81.0,156.0) U/L、86.5(25.0,224.8) U/L、2.0(2.0,2.0)分、10.0(6.3,20.0) mL、14 366.6(11 766.4,16 764.4)元,两组相比差异均具有统计学意义(P<0.05)。且两组患者在最近1个月急性发作病史、上腹部手术史、伴随高血压等方面差异也具有统计学意义(P<0.05)。而在糖尿病、冠心病、脑血管疾病、呼吸系统疾病、手术时间及非计Objective In order to explore the possibility of expanding the surgical indications of the ambulatory laparoscopic transcystic common bill duct exploration(LTCBDE).Methods A retrospective case-control study analysis was performed on the clinical data of 585 patients who underwent laparoscopic transcystic common bill duct exploration in the Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2018,including 155 cases of the ambulatory LTCBDE(study group)and 430 cases of the overnight LTCBDE(control group).The propensity score was used to match the related variables,and 144 pairs were successfully matched.The two groups were compared in surgery-related indicators,such the preoperative tests,history of acute exacerbation in the last one month,history of upper abdominal surgery,concomitant diseases(high blood pressure,diabetes mellitus,coronary heart disease,cerebrovascular disease and respiratory diseases),american society of anesthesiology(ASA)score,intraoperative bleeding,operation time,total medical costs,unplanned readmission rate.Measurement data with normal distribution were expressed as mean±standard deviation(±s),chi-square test was used for comparison between groups,and M(Q1,Q3)was used for measurement data with non-normal distribution.Fisher exact probability test and Wilcoxon rank-sum test were used for comparison between groups.Results The indexes of aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin,direct bilirubin(DBIL),alkaline phosphatase(ALP),gamma glutamyl transpeptidase(GGT),ASA score,intraoperative bleeding and total medical costs of the study group were 21.8(18.0,31.0)U/L,21.5(15.0,42.5)U/L,14.2(11.2,18.6)umol/L,2.6(2.1,3.5)μmol/L,91.0(73.3,118.5)U/L,44.5(22.0,109.8)U/L,2.0(2.0,2.0)grade,7.5(5.0,10.0)mL,9659.0(8704.8,10640.2)yuan respectively,and the control group were 26.0(17.7,45.3)U/L,29.5(16.0,85.5)U/L,17.2(13.0,27.5)μmol/L,3.8(2.4,8.7)μmol/L,105.0(81.0,156.0)U/L,86.5(25.0,224.8)U/L,2.0(2.0,2.0)grade,10.0(6.3,20.0

关 键 词：腹腔镜 胆结石 病例对照研究 日间手术 次日出院 经胆囊管胆道探查术 

分 类 号：R657.42[医药卫生—外科学]