两种微创手术治疗肝胆管结石的对比研究

发布时间：2018-01-19 04:34

本文关键词： 胆管结石经皮肝胆道造瘘碎石取石术腹腔镜胆总管切开取石术　出处：《中国现代医学杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的探讨经皮肝胆道造瘘碎石取石术与腹腔镜胆总管切开取石术治疗肝内外胆管结石的可行性及临床疗效。方法回顾性分析61例实施微创手术治疗的肝内外胆管结石患者的临床资料,其中行经皮肝胆道造瘘碎石取石术(PCH)26例,行腹腔镜胆总管切开取石术(LCC)35例。结果除4例因故转开腹手术外,两组患者手术均成功实施,未发生严重并发症。PCH组术中出血量与LCC组比较,差异有统计学意义(P0.05),PCH组术中出血量少于LCC组。PCH组胃肠功能恢复时间及住院时间与LCC组比较,差异有统计学意义(P0.05),PCH组胃肠功能恢复时间及住院时间均短于LCC组。而两组在手术时间、结石一次清除率及并发症发生率比较,差异无统计学意义(P0.05)。结论 PCH和LCC治疗肝胆管结石均可行、安全及有效,但在多次腹部手术史后胆管残余结石、复发结石或合并急性梗阻性化脓性胆管炎等患者中,PCH体现了独特的优势。
[Abstract]:Objective to evaluate percutaneous Hepatocholangiostomy lithotripsy and feasibility of laparoscopic common bile duct lithotomy treatment of intrahepatic biliary calculi and its clinical efficacy. Methods a retrospective analysis of the clinical data of 61 cases of extrahepatic bile duct stones underwent minimally invasive surgical treatment, including percutaneous transhepatic biliary fistula lithotripsy (PCH) 26 cases, laparoscopic choledocholithotomy (LCC) in 35 cases. Results 4 cases for conversion to open surgery, two patients were successful, no serious complications occurred in.PCH group bleeding compared with LCC group, the difference was statistically significant (P0.05), PCH group the bleeding volume was less than LCC group.PCH group, gastrointestinal function recovery time and hospitalization time compared with LCC group, the difference was statistically significant (P0.05), PCH group, gastrointestinal function recovery time and hospitalization time were shorter than LCC group. The two groups in the operation time, stone clearance rate and a concurrent The incidence rate of comparison, the difference was not statistically significant (P0.05). Conclusion PCH and LCC in the treatment of bile duct stones are feasible, safe and effective, but several times in the history of abdominal surgery after residual bile duct stones, patients with recurrent stones or with acute obstructive suppurative cholangitis, PCH reflects the unique advantages.

【作者单位】：汕头大学医学院第一附属医院普通外科;汕头大学医学院长江学者实验室;
【基金】：国家自然科学基金(No:81501539) 广东省自然科学基金(No:2015A030310211,2016A030312008) 广东省创新强校青年项目(No:2014KQNCX078) 广东省汕头市科技计划项目[No:汕府科(2014)62号]
【分类号】：R657.42
【正文快照】： 表1两组患者术前临床资料比较例(%)组别男性既往手术史合并AOSC巨大结石(最大直径≥2 cm)PCH(n=26)11(42.31)18(69.23)11(42.31)12(46.15)LCC(n=35)16(45.71)8(22.86)5(14.29)6(17.14)χ2值0.070 13.118 6.054 6.036P值0.791 0.000 0.014 0.014根据美国国家健康与营养调查结果

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