ERCP联合LC与开腹胆囊切除术对比研究

发布时间：2018-01-24 21:54

本文关键词： 胆囊结石胆总管结石腹腔镜胆囊切除术十二指肠镜　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比内镜下逆行胰胆管造影(ERCP)-内镜下Oddi氏括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石与开腹胆囊切除-胆总管切开取石术治疗胆囊结石合并胆总管结石对患者的术后生存质量的影响,探讨何种手术方式对患者的治疗更有利,从而确定何种手术方式更适合在目前的临床工作中应用。方法:经查阅相关病历资料,回顾性分析我们科室在2012年1月至2014年12月期间采用手术治疗的胆囊结石合并胆总管结石的患者共计147例,其中采用ERCP-EST联合LC手术治疗的病人共计96例(记为A组),行开腹胆囊切除-胆总管切开取石术的病人共51例(其中包括ERCP或LC手术失败而中转开腹的病人,记为B组),对比两组病人术前、术中及术后的情况,并归纳总结进行统计学分析。结果:纳入统计的两组病人分别记录,对比两组患者的一般情况(两组病人的男女比例,中位年龄,术前临床表现:腹痛、寒颤发热、黄疸,是否合并糖尿病、高血压高危因素的情况)、平均手术时间、平均术中出血量、平均住院时间、术后胰腺炎、腹痛、胆漏等常见并发症发生率及住院费用的平均值,最终结果对比如下:A组病人共计96例,其男、女比例为1:1.4,年龄范围23~82岁,中位年龄为59岁;B组病人共计51例,男、女比例为1:1.6,年龄范围38~89岁,中位年龄为64岁。A组病人的平均手术时间为40.73±18.84分钟,B组病人的平均手术时间为98.38±16.51分钟。A组病人手术中的平均失血量为13.15±6.67ml,B组病人手术中的平均失血量为53.37±10.82ml。A组病人的术后疼痛程度(术后一天的疼痛视觉评分:VAS评分)平均为4.11±1.15,B组病人的术后疼痛程度平均为7.49±2.78。A组病人的平均住院时间为4.67±1.32天,B组病人的平均住院时间为14.31±2.11天。A组病人的平均住院花费为30775.50±2659.75元,B组病人的平均住院花费为18980.72±3058.16元。A组病人的术后各种并发症(急性胰腺炎,胆总管残余结石,胆管损伤,胆瘘)的发生率平均为9.37%,B组病人的术后并发症发生率平均为3.92%。综上结果对比分析:在病人的手术时间、术中出血量、胆道并发症、术后疼痛程度(疼痛视觉评分:VAS)及住院时间方面A组明显低于B组(P0.05),差异具有统计学意义。结论:ERCP-EST联合LC治疗胆囊结石合并胆总管结石与传统开腹胆囊切除-胆总管切开取石术相比较具有手术时间短,手术之中出血量比较少,手术之后的并发症发生几率较低,手术之后病人的疼痛程度比较轻以及平均的住院日比较短等优势,三镜联合治疗胆囊结石合并胆总管结石值得在临床工作中广泛推行。
[Abstract]:Objective: to compare Oddi's sphincterotomy with endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC). The effect of cholecystolithiasis combined with choledocholithiasis and open cholecystectomy and choledocholithotomy on the postoperative quality of life of patients with cholecystolithiasis and choledocholithiasis. To explore which operation is more beneficial to the treatment of patients, so as to determine which kind of operation is more suitable for clinical application. Methods: by consulting the relevant medical records. A total of 147 cases of cholecystolithiasis complicated with choledocholithiasis treated surgically from January 2012 to December 2014 in our department were analyzed retrospectively. Among them, 96 cases were treated with ERCP-EST combined with LC (group A). A total of 51 patients with cholecystectomy and choledocholithotomy underwent cholecystectomy and choledocholithotomy (including patients with ERCP or LC who were converted to laparotomy) were recorded as group B and compared with the two groups before operation. Results: the two groups of patients were recorded and compared with the general situation of the two groups (ratio of male and female patients, median age of the two groups). Preoperative clinical manifestations: abdominal pain, chills, fever, jaundice, diabetes, hypertension high risk factors, the average operation time, average intraoperative bleeding, average hospitalization time, postoperative pancreatitis, abdominal pain. The incidence of common complications, such as bile leakage, and the average cost of hospitalization were compared as follows: 96 patients in group A, with a male to female ratio of 1: 1.4, age range of 2382 years. The median age was 59 years; There were 51 patients in group B, male and female ratio was 1: 1.6, the age range was 380.89 years old, the median age was 64 years old. The average operative time of group A was 40.73 卤18.84 minutes. The mean operative time of group B was 98.38 卤16.51 minutes. The mean blood loss in group A was 13.15 卤6.67 ml. Mean blood loss during operation in group B was 53.37 卤10.82ml.A patients' postoperative pain degree (visual score of pain 1 day after operation: VAS score). The average value was 4.11 卤1.15. The average postoperative pain in group B was 7.49 卤2.78.A and the average hospitalization time was 4.67 卤1.32 days. The average hospitalization time of patients in group B was 14.31 卤2.11 days. The average hospitalization cost of patients in group A was 30775.50 卤2659.75 yuan. The average hospitalization cost of group B was 18980.72 卤3058.16 yuan. The postoperative complications (acute pancreatitis, residual choledocholithiasis, bile duct injury) in group A. The average incidence of postoperative complications in group B was 3.92. Postoperative pain degree (visual score of pain: VAS1) and length of stay in group A were significantly lower than those in group B (P 0.05). Conclusion compared with the traditional open cholecystectomy and choledocholithotomy, the operation time is shorter than that of the traditional open cholecystectomy and choledocholithotomy in the treatment of cholecystolithiasis combined with choledocholithiasis. Less blood loss, lower incidence of postoperative complications, less pain after surgery and shorter average hospital stay were the advantages of less bleeding during surgery. Three-mirror combined treatment of cholecystolithiasis with choledocholithiasis is worthy of extensive clinical practice.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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