腹腔镜治疗胆总管结石伴胆囊结石的最佳术式研究

发布时间：2018-04-05 09:02

  本文选题：胆总管结石　切入点：胆囊切除术　出处：《中国全科医学》2017年02期

【摘要】：目的 探讨胆总管结石伴胆囊结石的最佳腹腔镜治疗方法。方法 选取2014年1月—2015年6月包头医学院第二附属医院收治的胆总管结石伴胆囊结石患者254例,患者行胆总管探查术,根据结石情况分为腹腔镜下经胆囊管取石术(LTSE)组和腹腔镜下胆总管切开取石术(LCBDE)组,LCBDE组患者经胆总管清除结石手术后被随机分配接受胆管一期缝合(一期缝合亚组)或T管引流(T管引流亚组)。比较LTSE组和LCBDE组患者结石清除率、并发症发生情况以及住院费用、住院时间等。结果 14例患者转行开放性手术,172例患者接受LTSE,68例患者接受LCBDE。LCBDE患者中,一期缝合34例,T管引流34例。LTSE组和LCBDE组性别、年龄、急性胆囊炎、结石清除率比较,差异均无统计学意义(P0.05);LTSE组结石数量、结石直径小于LCBDE组,手术时间、住院费用、住院时间短于LCBDE组(P0.05)。一期缝合亚组和T管引流亚组性别、年龄、急性胆囊炎、结石数量、结石直径、结石清除率比较,差异均无统计学意义(P0.05);一期缝合亚组手术时间、住院费用、住院时间短于T管引流亚组(P0.05)。LTSE组胆管并发症发生率低于LCBDE组(χ~2=6.461,P=0.011);两组其他并发症发生率比较,差异无统计学意义(χ~2=3.682,P=0.055);LTSE组总并发症发生率低于LCBDE组(χ~2=11.332,P=0.001)。结论 对于胆总管结石伴胆囊结石患者,LTSE应是首选治疗,较LCBDE更安全有效,费用低。对于行LCBDE者,一期缝合简单易行,可替代T管引流。
[Abstract]:Objective to explore the best laparoscopic treatment of choledocholithiasis with cholecystolithiasis.Methods 254 patients with choledocholithiasis associated with cholecystolithiasis were selected from January 2014 to June 2015 in the second affiliated Hospital of Baotou Medical College.According to the stone condition, the patients in the LCBDE group were randomly assigned to undergo primary suture of the bile duct after choledocholithiasis under laparoscopic transhepatic cholecystolithiasis (LTSE) and laparoscopic choledocholithotomy (LCBDE).Group B) or T-tube drainage group (T tube drainage subgroup).The stone clearance rate, complications, hospitalization cost and hospitalization time were compared between LTSE group and LCBDE group.Results among 14 patients undergoing open operation, 172 patients received LCBDE.LCBDE, 34 patients underwent primary suture with T tube drainage. Sex, age, acute cholecystitis, stone clearance rate were compared between LTSE group and LCBDE group.There was no significant difference in the number of stones, the diameter of stones was smaller than that in LCBDE group, the operation time, hospitalization cost and hospitalization time were shorter than those in LCBDE group.There were no significant differences in sex, age, acute cholecystitis, stone number, stone diameter, stone clearance rate between primary suture subgroup and T tube drainage subgroup (P 0.05).浣忛櫌鏃堕棿鐭�浜嶵绠″紩娴佷簹缁，

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