腹腔镜胆囊切除术与微创保胆取石术治疗胆石症术后不良反应的对比研究

摘要

Objective:To investigate the postoperative complications of laparoscopic cholecystectomy (LC) and laparoscopic-assisted endoscopie cholecystolithotomy (LEC) in the treatment of cholelithiasis,and the influence of two kinds of operation on patient's quality of life.Methods:The postoperative complications of 1 244 patients with LC and 208 patients with LEC were retrospectively analyzed,and the postoperative quality of life was evaluated by gastrointestinal quality of life index (GLQI).Results:All patients were followed-up for average (3.4 ± 1.7) years.The total complication,gallbladder resection syndrome,bile leakage at gallbladder bed,intestinal obstruction,choledocholith and reflux esophagitis incidence after operation in LC group was 32.6％ (405 cases),9.1％ (113 cases),2.2％ (27 cases),1.9％ (24 cases),5.8 (72 cases) and 12.4％ (154 cases),which were significantly higher than 13％ (27 cases),1.0 (2 cases),0％,0％,1.4％ (3 cases) and 6.3 ％ (13 cases) in LEC group.Recurrent gallstone rate in LEC group was 3.8％ (8 cases).The GLQI in LEC group was (124.7 ± 10.3) points,and it was significantly higher than (104.9 ± 9.6) points in LC group.Conclusions:Postoperative complication of LEC is less than that of LC in cholelithiasis patients,and the postoperative quality of life of LEC is higher than that of LC.Because the indications of the two operations are different,LEC is not completely better than LC and cannot replace LC.Clinical strategy should be decided according to specific situation of each patient.%目的:了解胆石症患者行腹腔镜胆裳切除术(laparoscopic cholecystectomy,LC)与腹腔镜辅助胆道镜保胆取石术(laparoscopic-assisted endoscopic cholecystolithotomy,LEC)术后并发症情况,以及两种术式对患者生存质量的影响.方法:回顾分析1 244例LC患者及208例LEC患者术后并发症情况,采用消化病生存质量指数(gastrointestinal quality of life index,GLQI)评价患者术后生存质量.结果:平均随访(3.4±1.7)年,LC组术后总的并发症、胆囊切除术后综合征、胆囊床胆汁漏、术后肠梗阻、胆总管结石及反流性食管炎的发生率分别为32.6％(405例)、9.1％(113例)、2.2％(27例)、1.9％(24例)、5.8(72例)与12.4％(154例),均显著高于LEC组的13％(27例)、1.0％(2例)、0、0、1.4％(3例)、6.3％(13例).LEC组胆囊结石复发率为3.8％(8例),GLQI指数平均(124.7±10.3)分,显著高于LC组的(104.9±9.6)分.结论:胆石症患者行LEC术后并发症发生率明显低于LC,术后生活质量高于LC.但由于两种术式适应证不尽相同,因此不能完全认为LEC优于甚至可取代LC,临床决策尚需结合患者具体病情综合考虑.