小切口法在困难型腹腔镜胆总管切开取石术中的效果观察

摘要

目的：观察小切口法在处理困难型腹腔镜胆总管切开取石术或胆总管探查取石术中的治疗效果。方法回顾该院2010年10月至2014年5月完全腹腔镜联合纤维胆道镜手术操作困难患者42例，按改用术式不同分为两组，A 组为改用小切口法完成手术患者共30例，B 组为改用中转传统开腹手术患者共12例，统计分析两组患者在腹壁创伤（切口长度）、手术时间、术中出血量、术后疼痛、术后首次下床时间、切口并发症发生率、住院时间等方面指标，比较两组患者治疗效果。结果两组患者均痊愈出院。 A 组和 B 组相比较，腹壁创伤（切口长度）分别为（3．3±0．5）、（8．3±2．0）cm（P＜0．01）；手术时间分别为（150±30）、（138±33）min（P ＞0．05）；术中出血量分别为（12±5）、（50±31）mL（P＜0．01）；术后镇痛泵使用率分别为15．6％、91．7％（P＜0．01）；术后首次下床时间分别为（26．0±4．3）、（46．0±10．5）h（P＜0．01）；住院时间分别为（7．1±2．3）、（10．5±3．3）d（P＜0．01），切口并发症发生率分别为0、16．7％（P＜0．01）。结论小切口法是处理困难型腹腔镜胆总管切开取石术的有效方法，较传统中转开腹手术具有创伤小，出血量少，术后疼痛发生率低，下床早，住院时间短等优点，值得推广。%Objective To observe the effects of small incision surgical method in processing the difficult type of laparoscopic common bile duct choledocholithotomy and laparoscopic common bile duct exploration (LCBDE ) li‐thotomy .Methods 42 cases of difficult operating in complete laparoscopy combined with choledochofiberscopy in our hospital from October 2010 to May 2014 were retrospectively analyzed and divided into the two groups according to the used operation modes .The group A used the small incision method to complete the operation in 30 cases and the group B was converted to the traditional open surgery in 12 cases .The abdominal wall trauma (incision length) ,oper‐ative time ,intraoperative blood loss ,postoperative pain ,postoperative first time ambulation time ,incidence of incision complications and hospitalization time were statistically analyzed .The curative effects were compared between the two groups .Results The patients in the two groups were cured and discharged from hospital .In the comparison be‐tween the group A and the group B ,the abdominal wall trauma (incision length) was (3 .3 ± 0 .5)cm and (8 .3 ± 2 .0) cm (P< 0 .01) ,operative time was (150 ± 30)min and (138 ± 33)min(P > 0 .05) ,intraoperative blood loss volume was (12 ± 5)mL and (50 ± 31)mL (P < 0 .01) ,use rates of postoperative analgesic pump were 15 .6% and 91 .7%(P< 0 .01) ,postoperative first time ambulation time was (26 .0 ± 4 .3)h and (46 .0 ± 10 .5) h(P< 0 .01) ,hospitaliza‐tion time was (7 .1 ± 2 .3) d and (10 .5 ± 3 .3) d(P < 0 .01)and the incidence rates of incision complications were 0 and 16 .7% respectively (P< 0 .01) .Conclusion The small incision method is an effective method in processing the difficult common bile duct lithotomy ,compared with the traditional laparotomy surgery ,which has the advantages of small trauma ,less bleeding ,low incidence rate of postoperative pain ,early ambulation and short hospitalization time , and is worthy of promotion .