腹腔镜再次胆道手术联合中医药技术治疗肝胆管结石的效果研究  

Study on effect of laparoscopic reoperation on biliary tract combined with traditional Chinese medicine in the treatment of hepatobiliary calculi

作　　者：秦红军 郭恺 丁严江 支春平 胡仁健 QIN Hong-jun;GUO Kai;DING Yan-jiang(Department of Hepatobiliary Pancreatic and Splenic Surgery,Leshan Traditional Chinese Medicine Hospital,Leshan 614000,China)

机构地区：[1]乐山市中医医院肝胆胰脾外科,614000

出　　处：《中国实用医药》2023年第18期26-30,共5页China Practical Medicine

摘　　要：目的评价腹腔镜再次胆道手术联合中医药技术治疗肝胆管结石的临床效果。方法323例进行过1次胆道手术的肝胆管结石患者,按照随机数字表法分为研究组(183例)和对照组(140例)。研究组采用腹腔镜再次胆道手术联合中医药技术治疗,对照组采用传统开腹再次胆道手术治疗。比较两组手术相关情况、术后留置情况、并发症发生情况、术后阿片类药物使用情况及预后情况。结果研究组术前禁饮时间(2.69±1.23)h、术前禁食时间(6.82±1.80)h、持续心电监护时间(5.58±1.86)h、术后下床活动时间(10.44±7.12)h、术后排气时间(26.55±8.45)h、术后住院时间(4.24±1.06)d均短于对照组的(12.87±3.60)h、(13.16±3.49)h、(18.80±3.80)h、(29.98±8.45)h、(32.18±10.13)h、(7.13±1.28)d,住院费用(14431.27±1533.15)元少于对照组的(17921.43±2936.16)元,差异有统计学意义(P<0.05)。研究组术后胃肠减压管留置率5.46%、导尿管留置率4.37%、T管留置率3.28%均低于对照组的42.86%、42.86%、48.57%,胃肠减压管留置时间(6.72±1.11)h、导尿管留置时间(7.01±1.10)h、T管留置时间(3.15±1.44)d均短于对照组的(38.22±6.80)h、(20.50±4.12)h、(5.65±2.07)d,差异有统计学意义(P<0.05)。研究组并发症发生率7.65%、术后阿片类药物使用率3.83%明显低于对照组的17.86%、24.29%,差异有统计学意义(P<0.05)。结论采用腹腔镜再次胆道手术联合中医药技术治疗肝胆管结石,加快了患者术后胃肠功能恢复,降低了并发症发生率,其方法安全可行,值得推广。Objective To evaluate the clinical effect of laparoscopic reoperation on biliary tract combined with traditional Chinese medicine in the treatment of hepatobiliary calculi.Methods A total of 323 patients with recurrent hepatobiliary calculi after biliary surgery were divided into study group(183 cases)and control group(140 cases)according to the random numerical table.The study group was treated with laparoscopic reoperation on biliary tract and traditional Chinese medicine,and the control group was treated with conventional open biliary surgery.The surgery-related conditions,postoperative indwelling catheter,complications,postoperative opioid use and prognosis were compared between the two groups.Results In the study group,the preoperative duration of water-deprivation was(2.69±1.23)h,the preoperative fasting time was(6.82±1.80)h,the continuous ECG monitoring time was(5.58±1.86)h,the postoperative off-bed ambulation time was(10.44±7.12)h,the postoperative exhaust time was(26.55±8.45)h,and the postoperative hospitalization time was(4.24±1.06)d,which were shorter than those of(12.87±3.60)h,(13.16±3.49)h,(18.80±3.80)h,(29.98±8.45)h,(32.18±10.13)h,and(7.13±1.28)d in the control group;the hospitalization cost of(14431.27±1533.15)yuan in the study group was less than that of(17921.43±2936.16)yuan in the control group;the differences were statistically significant(P<0.05).Postoperatively,in the study group,the indwelling rate of gastrointestinal decompression tube was 5.46%,the indwelling rate of urinary catheter was 4.37%and the indwelling rate of T-tube was 3.28%,which were lower than those of 42.86%,42.86%and 48.57%in the control group;the indwelling time of gastrointestinal decompression tube was(6.72±1.11)h,the indwelling time of urinary catheter was(7.01±1.10)h and the indwelling time of T-tube was(3.15±1.44)d,which were shorter than those of(38.22±6.80)h,(20.50±4.12)h and(5.65±2.07)d in the control group;the differences were statistically significant(P<0.05).The complication rate of the study

关 键 词：肝胆管结石 腹腔镜再次胆道手术 中医药技术 效果 

分 类 号：R657.4[医药卫生—外科学]