三种微创方式治疗胆囊结石合并胆总管结石的临床研究

发布时间：2018-01-20 09:56

  本文关键词： 胆囊结石 胆总管结石 T管引流术 一期缝合术 三镜联合一期缝合术　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过观察肝下引流时间、术后住院时间、手术费用、胆漏、急性胰腺炎及残留结石等多项指标,对比分析三种治疗胆囊结石合并胆总管结石的微创方式——腹腔镜下胆囊切除胆总管探查T管引流术,腹腔镜下胆囊切除胆总管探查一期缝合术和腹腔镜-胆道镜联合十二指肠镜一期缝合术的临床疗效。探讨以上三种微创术式在治疗胆囊结石合并胆总管上的临床治疗效果及各自优缺点,以期为临床医生治疗胆囊结石合并胆总管结石最适手术方式的选择提供参考和依据。方法:收集大连医科大学附属第一医院普通外科2014年1月至2016年12月诊治的153例胆囊结石合并胆总管结石患者的病例资料。根据入院后手术方式分为三组:腹腔镜下胆囊切除胆总管探查T管引流术(A组)108例,腹腔镜下胆囊切除胆总管探查一期缝合术(B组)31例,腹腔镜-胆道镜联合十二指肠镜一期缝合术(C组)13例。A组患者行腹腔镜下胆囊切除术(laparoscopic cholecystomy,LC)+腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)+T管引流术(T-tube drainage,TD);B组患者行LC+LCBDE+一期缝合术(primary suture,PS);C组患者先行LC+LCBDE切除胆囊并取净胆总管结石,随后行经内镜鼻胆管引流术(endoscopic nasobibiary,ENBD)+PS。通过对比分析三组病例的一般临床资料,包括性别、年龄、胆总管内径、结石数目、结石最大直径和术前肝功能,检验各组之间是否具有可比性。然后,分析三种手术方式在肝下引流管放置时间、术后住院时间、手术费用、术后胆漏、胰腺炎及残留结石等并发症方面的差异。结果:1.一般临床资料:经统计分析三组病例在性别、年龄、胆总管直径、结石数目、结石最大直径和术前肝功能方面的差异不具有显著性(P(29)0.05),表明从一般临床资料来看,各组之间具有可比性。2.术后情况:B组和C组的术后肝下引流时间及术后住院时间均明显短于A组(P(27)0.05)。然而,B组与C组在术后肝下引流时间和术后住院时间相比无明显区别(P(29)0.05)。3.术后并发症:三组病例在术后胆漏、急性胰腺炎、结石残留和总并发症发生率方面相比较,结果显示各组之间的差异均无统计学意义(P(29)0.05)。4.手术费用:C组的手术费用明显高于A、B两组,且差异具有显著性(P(27)0.05);A组和B组患者在手术费用上的差异同样具有显著性,B组的费用明显低于A组(P(27)0.05)。结论:在本研究纳入的临床病例中,通过对上述三种不同微创术式相比,腹腔镜-胆道镜联合十二指肠镜一期缝合术这一新的微创术式治疗胆囊结石合并胆总管结石的临床疗效明显,是安全、可行的,缩短了术后引流时间、住院时间,且并未增加胆漏和结石残留。在具备各项硬件及软件的前提下,严格掌握手术适应症和操作技巧的情况下,三镜联合一期缝合术可作为治疗胆囊结石合并胆总管结石的首选术式,值得临床广泛推广。
[Abstract]:Objective: This study through the observation of hepatic drainage time, postoperative hospitalization time, cost of surgery, bile leakage, acute pancreatitis and residual calculus index, comparative analysis of three kinds of treatment of cholecystolithiasis and choledocholithiasis: minimally invasive laparoscopic cholecystectomy and common bile duct exploration and T tube drainage, the clinical curative effect of laparoscopic cholecystectomy choledochotomy and laparoscopic suture - choledochoscope duodenoscope suture. To investigate the clinical effect of more than three kinds of minimally invasive surgery in the treatment of cholecystolithiasis with common bile duct and the respective advantages and disadvantages, the optimal choice of surgical approach and provide a reference basis for clinical treatment of gallbladder and bile choledocholithiasis. Methods: general surgery from January 2014 to December 2016 the First Affiliated Hospital of Dalian Medical University collected 153 cases of cholecystolithiasis and choledocholithiasis patients The case data. According to the operation were divided into three groups: laparoscopic cholecystectomy and common bile duct exploration and T tube drainage (A group) 108 cases, laparoscopic exploration of common bile duct suture (group B) 31 cases, laparoscopic - choledochoscope and duodenoscope (a suture C group) 13 cases of.A patients who underwent laparoscopic cholecystectomy (laparoscopic cholecystomy, LC) + laparoscopic common bile duct exploration (laparoscopic common bile duct exploration, LCBDE) +T tube drainage (T-tube drainage, TD); group B underwent LC+LCBDE+ stage suture (primary suture, PS C); the LC+LCBDE group patients were given cholecystectomy and common bile duct stones were removed, then underwent endoscopic nasobiliary drainage (endoscopic nasobibiary, ENBD +PS.) through the comparative analysis of the clinical data of three cases including gender, age, diameter of common bile duct stones, the number and the diameter of the largest stone 鏈�鍓嶈倽鍔熻儯�

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