腹腔镜辅助胆管镜与完全腹腔镜保胆取石术治疗胆囊结石疗效比较

摘要

Objective To compare the clinical effects and safety of laparoscopic-assisted choledocho-scopic and totally laparoscopic cholecystolithotomy in the treatment of gallbladder stone .Methods Total of 36 patients with gallbladder stone and treated in Fujian Provincial Border Defense Corps Hospital from Jan . 2012 to Jan.2014 were included as the research objects,and these patients were randomly divided into a control group and an observation group according to the drawing lots method,18 patients in each group.The control group was treated with the totally laparoscopic cholecystolithotomy , while the observation group was treated with the laparoscopic-assisted choledochoscopic cholecystolithotomy .The clinical effect and complica-tions of the two groups were compared.Results In the observation group,the operation time was (55.2 ± 1.23) min,intraoperative bleeding was (8.8 ±1.2) mL,intestinal peristalsis recovery time was (1.3 ± 0.4) d,the hospitalization time was (4.1 ±1.0) d, hospitalization expenses was (6.1 ±1.1) thousand yuan,which were lower than those in the control group′s (60.0 ±2.2) min, (12.8 ±3.2) mL, (1.6 ± 0.5) d, (4.2 ±1.0) d,(6.8 ±1.5) correspondingly,and there were significant differences in the intraop-erative blood loss and operative time(P<0.05) while there were no significant differences in intestinal peri-stalsis recovery time,hospitalization time and hospitalization expense;there was no complication in the obser-vation group,while there were 2 cases of bile leakage,2 cases of bleeding in the control group, the incidence of complications was 22.22%.There was significant difference in the incidence of complications between the two groups(P <0.05).Conclusion The clinical effects of laparoscopic-assisted choledochoscopic in the treatment of gallbladder stone are significant,which can reduce the amount of bleeding and operation time and it has the advantages of small operation wound and high safety,thus should be promoted in the clinical practice.%目的：比较腹腔镜辅助胆管镜保胆取石术与完全腹腔镜保胆取石术对胆囊结石患者的临床疗效及安全性。方法选取于2012年1月至2014年1月武警福建省边防总队医院收治的胆囊结石患者36例，采用抽签法分为对照组和观察组，各18例，对照组行完全腹腔镜保胆取石术治疗，观察组行腹腔镜辅助胆管镜保胆取石术治疗，比较两组患者的临床疗效及并发症发生情况。结果观察组的手术时间为（55.2±1.2） min、术中出血量为（8.8±1.2） mL、肠蠕动恢复时间为（1.3±0.4） d、住院时间为（4.1±1.0） d、住院费用为（6.1±1.1）千元，对照组手术时间（60.0±2.2） min、术中出血量（12.8±3.2） mL、肠蠕动恢复时间（1.6±0.5） d、住院时间（4.2±1.0） d、住院费用（6.8±1.5）千元，观察组的术中出血量少于对照组、手术时间显著短于对照组（P＜0.01），两组术后肠蠕动时间、住院时间及住院费用比较差异无统计学意义（ P＞0.05）；观察组无并发症发生，对照组有2例胆瘘、2例出血，并发症发生率为22.22％，两组并发症发生率比较差异有统计学意义（ P ＜0.05）。结论胆囊结石患者采用腹腔镜辅助胆管镜保胆取石术的临床疗效显著，可减少术中出血量，缩短手术时间，具有手术创伤小、安全性高等优点，值得临床推广应用。