胆总管结石不伴胆囊结石微创治疗方法的临床疗效对比研究

发布时间：2018-04-11 12:32

本文选题：胆总管结石 + 保留胆囊　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:研究不同微创方式治疗胆总管结石不伴有胆囊结石的临床效果。方法:回顾性分析我院2013年9月至2014年12月期间收治的胆总管结石不伴胆囊结石手术治疗的83例患者的临床资料,按其手术方式分为4组。A组21例:行腹腔镜下胆总管切开取石一期缝合术,术中保留胆囊;B组25例:行腹腔镜下胆囊切除+腹腔镜下胆总管切开取石一期缝合术;C组18例:腹腔镜下胆囊切除术+腹腔镜下胆总管切开取石术+T管引流术;D组19例:内镜下十二指肠乳头括约肌切开取石术。对比观察4组患者的术前指标、术中治疗、术后恢复情况等相关临床指标。结果:A组21例患者均完成保留胆囊的腹腔镜下胆总管切开取石一期缝合术,术中未切除胆囊,且均未放置T管,术后未出现胆瘘、结石残留等并发症,术后随访24个月以上均未见结石复发;B组25例患者均完成腹腔镜下胆总管切开取石一期缝合术同时切除胆囊,术中也均未放置T管,术后1例患者出现胆瘘,1例患者术后第18月时复发胆总管结石;C组18例均完成腹腔镜下胆囊切除术+腹腔镜下胆总管切开取石术+T管引流术,术后2例患者发现胆道残余结石,1例患者术后24月时复发胆总管结石;患者D组19例患者均完成内镜下十二指肠乳头括约肌切开取石术,术后2例患者出现轻型胰腺炎,1例在术后第9个月时出现反流性胆管炎,术后18月时复发胆总管结石。4组患者术前白细胞水平、术前白蛋白水平相似,差异无统计学意义(P均0.05);而A组术前B超检查胆囊壁厚度最薄,与其他三组相比差异有统计学意义(P均0.05);在术前胆红素水平方面,C组最高(P0.05)。4组患者的结石发生情况方面:A组单发结石的例数更多(P0.05);结石]顿情况方面,A组例数最少(P0.05);C组住院时间最长、手术时间(P0.05);在术中出血量、总住院费用方面4组差异无统计学意义(P均0.05)。结论:4种微创方式治疗胆总管结石不伴胆囊结石各有利弊,临床需根据患者的情况采用个体化方式进行选择;对于胆总管结石不伴有胆囊结石且胆囊功能良好的患者,在满足手术适应症时行保留胆囊的腹腔镜下胆总管切开取石一期缝合术是安全、有效的。
[Abstract]:Objective: to study the clinical effect of different minimally invasive treatment of choledocholithiasis without cholecystolithiasis.Methods: the clinical data of 83 patients with choledocholithiasis without cholecystolithiasis treated in our hospital from September 2013 to December 2014 were retrospectively analyzed.According to its operation mode, 21 cases were divided into 4 groups. Group A: laparoscopic choledocholithotomy and primary suture.Group B 25 cases: laparoscopic cholecystectomy laparoscopic choledocholithotomy with primary suture and group C 18 cases with laparoscopic cholecystectomy laparoscopic choledocholithotomy T tube drainageGroup D: endoscopic sphincterotomy of duodenal papilla.The clinical indexes such as preoperative index, intraoperative treatment and postoperative recovery were compared among the 4 groups.Results 21 patients in group A underwent laparoscopic choledocholithotomy and primary suture of choledocholithiasis without cholecystectomy, and no T-tube was placed. There were no complications such as biliary fistula, residual stone, and so on.All the 25 patients in group B underwent laparoscopic choledocholithotomy and cholecystectomy with cholecystectomy, and no T-tube was placed during the operation.Postoperative biliary fistula occurred in 1 patient. In group C, 18 patients underwent laparoscopic cholecystectomy and choledocholithotomy with T-tube drainage, 18 patients suffered from recurrent choledocholithiasis at the 18th month after operation, and 18 patients underwent laparoscopic cholecystectomy with choledocholithotomy.After operation, 1 patient with bile duct residual stone and 19 patients with choledocholithiasis recurred 24 months after operation, 19 patients in group D underwent endoscopic sphincterotomy of duodenal papillary sphincter.One patient developed reflux cholangitis at the 9th month after operation, and the preoperative leukocyte and albumin levels were similar in the group of 4 patients with recurrent choledocholithiasis at 18 months after operation.There was no significant difference in the thickness of gallbladder wall between two groups (P < 0.05), but the thickness of gallbladder wall was the thinnest in group A by B-ultrasound before operation.Compared with the other three groups, the difference was statistically significant (P < 0.05); in terms of preoperative bilirubin level, the highest level of bilirubin was found in group C (P 0.05) and the incidence of single stone in group A was more than that in group A (P 0.05).The length of stay in group C was the longest.There was no significant difference in blood loss and total hospitalization cost among the four groups (P < 0.05).Conclusion the four minimally invasive methods for the treatment of choledocholithiasis without gallstone have their advantages and disadvantages, and the patients with choledocholithiasis without cholecystolithiasis and with good cholecystolithiasis should be selected by individualized method according to the situation of the patients with choledocholithiasis.Laparoscopic choledocholithotomy and primary suture for choledocholithotomy is safe and effective.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.42

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