完全腹腔镜下治疗成人Ⅰ型先天性胆管扩张症的疗效分析

发布时间：2018-03-06 04:28

本文选题：腹腔镜　切入点：先天性胆管扩张症　出处：《南昌大学》2015年硕士论文　论文类型：学位论文

【摘要】：先天性胆管扩张症(Congenital Biliary Dilatation,CBD)一经明确诊断应尽早手术治疗,以防诱发胆管炎、胰腺炎、肝内肝外胆管结石、胆汁性肝硬化、囊肿破裂甚至恶变。目前公认的治疗先天性胆管扩张症(CBD)的标准术式是囊肿切除+胆管空肠Roux-en-Y吻合术。1995年国外学者报道在腹腔镜辅助下完成囊肿切除+胆管空肠Roux-en-Y吻合术治疗儿童先天性胆管扩张症取得了良好的效果。成年患者病程较长,腹腔镜手术操作难度大,完全腹腔镜下手术对术者技术要求高,开展较晚。目的:对比分析南昌大学第二附属医院完全腹腔镜手术和传统开腹手术两种不同手术方式下患者术中及术后情况的差异,探讨完全腹腔镜下治疗成人I型先天性胆管扩张症的安全性及可行性。方法:回顾南昌大学第二附属医院肝胆外科2010年3月~2014年10月间手术治疗的53例成人I型先天性胆管扩张症患者的病例资料。按手术方式分为完全腹腔镜手术组(A组)和传统开腹手术组(B组),其中A组22例,B组31例。比较两组病例的手术时间、术中出血量、术后排气时间、术后住院时间、术后并发症、术后肝功能指标及术后镇痛情况。采用卡方检验分析患者术前一般资料、术后并发症和术后镇痛情况;采用两样本比较t检验分析两组病例的手术时间、术中出血量、术后排气时间、术后住院时间和术后肝功能指标,使用SPSS 22.0统计软件进行计算,以α=0.05为检验水准。结果:1、一般情况:两组病例在年龄分布、性别比例、囊肿直径各项指标之间的差异均无统计学意义;2、术中情况:完全腹腔镜手术组手术时间长于传统开腹手术组,但术中出血量少于传统开腹手术组(P0.01);3、术后情况:完全腹腔镜手术组患者术后排气时间早于传统开腹手术组,住院时间短于传统开腹手术组(P0.05);完全腹腔镜组手术对肝功能损伤程度小于传统开腹手术组(P0.05);术后镇痛患者少于传统开腹手术组;(P0.05);在术后并发症方面的比较差异无统计学意义(P0.05)。结论:1、完全腹腔镜下治疗成人I型先天性胆管扩张症是安全、可行的;2、完全腹腔镜下治疗成人I型先天性胆管扩张症手术时间长于传统开腹手术,但其对肝功能损伤小、疼痛轻,术后恢复优于传统开腹手术。
[Abstract]:Once the diagnosis of congenital cholangiectasis is confirmed, surgical treatment should be done as soon as possible to prevent the development of cholangitis, pancreatitis, extrahepatic cholelithiasis and biliary cirrhosis. Cyst rupture or even malignant change. The standard procedure for the treatment of congenital cholangiectasis is cystectomy and jejunojejunostomy (Roux-en-Y). In 1995, foreign scholars reported that cystectomy was performed under laparoscopically assisted cholangiojejunostomy. Roux-en-Y anastomosis has achieved good results in the treatment of congenital cholangiectasis in children. The operation of laparoscopic surgery is very difficult. Objective: to compare and analyze the difference of the operative and postoperative conditions between the complete laparoscopic surgery and the traditional open surgery in the second affiliated Hospital of Nanchang University. To investigate the safety and feasibility of complete laparoscopy in the treatment of adult type I congenital cholangiectasis methods: a retrospective review of 53 cases of adult type I treated by hepatobiliary surgery from March 2010 to October 2014 in the second affiliated Hospital of Nanchang University. The data of patients with congenital cholangiectasis were divided into two groups: complete laparoscopic operation group (group A) and traditional open operation group (group B: 31 cases, group A: 22 cases, group B, n = 31). The operative time was compared between the two groups. Blood loss, postoperative exhaust time, postoperative hospital stay, postoperative complications, postoperative liver function and postoperative analgesia were analyzed by chi-square test. The operation time, intraoperative bleeding volume, postoperative exhaust time, postoperative hospitalization time and postoperative liver function index of the two groups were analyzed by t-test. The results were calculated by SPSS 22.0 software. Results: 1, general situation: two groups of cases in age distribution, sex ratio, There was no significant difference in the diameter of cysts between the two groups. The operative time of complete laparoscopic surgery group was longer than that of traditional laparotomy group. However, the amount of intraoperative bleeding was less than that of the traditional laparotomy group (P 0.01). After operation, the postoperative exhaust time of the patients in the complete laparoscopic operation group was earlier than that in the traditional open operation group. The duration of hospitalization was shorter than that of the traditional laparotomy group (P 0.05), the degree of liver function injury in the complete laparoscopy group was less than that in the traditional open operation group (P 0.05), the postoperative analgesia was less than that in the traditional open operation group (P 0.05), and there was no difference in postoperative complications. Conclusion: it is safe to treat adult type I congenital cholangiectasis with complete laparoscopy. The operative time of complete laparoscopy in the treatment of adult type I congenital cholangiectasis is longer than that of traditional open surgery, but it has less damage to liver function and less pain, and the postoperative recovery is better than that of traditional open surgery.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.44

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