不同手术方式治疗肝胆管结石的临床疗效观察
发布时间：2018-08-19 12:31
【摘要】：研究目的:有关肝胆管结石的治疗方式,主要有传统的开腹手术与近年来逐渐被临床更多运用的微创手术治疗两种方式。总体来讲微创治疗在胆石症方面已更为广泛应用于临床,尤其是在胆囊切除方面。那么,对于肝胆管结石的微创治疗因手术难度增加,对病例病变范围有所选择性(一般为慢性,年龄不能过高,基础疾病较少)及微创特有的电刀副损伤及CO2气腹对患者的影响是否优于传统开腹手术治疗方式。这些提示我们从一系列相关指标(手术时间、术中出血量、术后引流管留置时间、术后并发症发生率、结石复发率、残石率)中,探究不同手术方式治疗肝胆管结石的临床疗效。研究方法:1.择取山西医科大学第二医院普外科2012年6月~2014年9月收治的64例肝胆管结石患者的病历资料。2.按照手术方式不同分成两组,对照组实施传统手术治疗,实验组实施微创手术治疗,对比两组临床治疗效果。3.通过统计学分析计算比较2组间手术时间、术中出血量、术后引流管留置时间,并详细分析各组术后并发症发生率,结石复发率及残石率。4.最后,利用卡方检验分析微创手术治疗肝胆管结石是否优于传统手术。研究结果:1.实验组手术时间(min:120.28±11.67 vs 141.36±13.52)、术中出血量(ml:79.35±9.71 vs 146.34±12.25)及术后引流管留置时间(d:3.23±1.21 vs4.93±3.34)均短于对照组。这些观察指标的降低能反映手术的安全性。2.实验组术后并发症发生率(0 vs 18.75%)、结石复发率(0 vs 21.87%)、残石率(6.25%vs 25.006.25%)均低于对照组,差异具有显著统计学意义(P0.05)。而这些观察指标下降则是对治疗效果的一个评价。研究结论:1.通过本实验观察研究,得出微创手术的手术时间短、术中出血少、术后引流管留置时间短,术后并发症发生率低,结石复发率小、残石率低。微创手术治疗肝胆管结石临床疗效确切,安全指数高;2.微创手术治疗肝胆管结石疾病具有一定优势,临床上应引起足够重视,但应注意提高手术操作熟练度、避免微创手术特有的副损伤。
[Abstract]:Objective: the treatment of hepatolithiasis mainly includes traditional open surgery and minimally invasive surgery, which has been used more and more in clinical practice in recent years. Generally speaking, minimally invasive therapy has been widely used in cholelithiasis, especially in cholecystectomy. So, the minimally invasive treatment for hepatolithiasis is more difficult to operate on and selective for the range of lesions (usually chronic, not too old). The effect of electrosurgical accessory injury and CO2 pneumoperitoneum on patients is better than that of traditional open surgery. These suggest that in a series of related indicators (operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative complication rate, stone recurrence rate, residual stone rate), To explore the clinical efficacy of different surgical methods in the treatment of hepatolithiasis. Research method: 1. The medical records of 64 patients with hepatolithiasis admitted from June 2012 to September 2014 in the Department of General surgery of the second Hospital of Shanxi Medical University were collected. According to the different operation methods, the control group was treated with traditional operation, the experimental group was treated with minimally invasive surgery, and the two groups were compared with each other. The time of operation, the amount of intraoperative bleeding and the time of drainage tube indwelling were calculated and compared by statistical analysis. The incidence of postoperative complications, the recurrence rate of stone and the rate of residual stone were analyzed in detail. Finally, chi-square test is used to analyze whether minimally invasive surgery is superior to traditional surgery in the treatment of hepatolithiasis. The result of the study was: 1. The operative time (min:120.28 卤11.67 vs 141.36 卤13.52), intraoperative bleeding volume (ml:79.35 卤9.71 vs 146.34 卤12.25) and postoperative drainage tube retention time (d: 3.23 卤1.21 vs4.93 卤3.34) in the experimental group were shorter than those in the control group. The decrease of these indexes can reflect the safety of the operation. 2. The incidence of postoperative complications (0 vs 18.75%), the recurrence rate of stones (0 vs 21.87%) and the residual stone rate (6.25%vs 25.006.25%) in the experimental group were significantly lower than those in the control group (P0.05). The decline in these observational indicators is an assessment of therapeutic effectiveness. Conclusion: 1. The results showed that the operation time was short, the bleeding was less, the time of drainage tube indwelling was short, the incidence of postoperative complications was low, the recurrence rate of stone was small, and the rate of residual stone was low. Minimally invasive surgery was effective in the treatment of hepatolithiasis with a high safety index of 2. Minimally invasive surgery has some advantages in the treatment of hepatolithiasis, which should be paid enough attention to clinically, but it should be paid more attention to improve the skill of operation and avoid the special collateral injury of minimally invasive surgery.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
本文编号：2191658
[Abstract]:Objective: the treatment of hepatolithiasis mainly includes traditional open surgery and minimally invasive surgery, which has been used more and more in clinical practice in recent years. Generally speaking, minimally invasive therapy has been widely used in cholelithiasis, especially in cholecystectomy. So, the minimally invasive treatment for hepatolithiasis is more difficult to operate on and selective for the range of lesions (usually chronic, not too old). The effect of electrosurgical accessory injury and CO2 pneumoperitoneum on patients is better than that of traditional open surgery. These suggest that in a series of related indicators (operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative complication rate, stone recurrence rate, residual stone rate), To explore the clinical efficacy of different surgical methods in the treatment of hepatolithiasis. Research method: 1. The medical records of 64 patients with hepatolithiasis admitted from June 2012 to September 2014 in the Department of General surgery of the second Hospital of Shanxi Medical University were collected. According to the different operation methods, the control group was treated with traditional operation, the experimental group was treated with minimally invasive surgery, and the two groups were compared with each other. The time of operation, the amount of intraoperative bleeding and the time of drainage tube indwelling were calculated and compared by statistical analysis. The incidence of postoperative complications, the recurrence rate of stone and the rate of residual stone were analyzed in detail. Finally, chi-square test is used to analyze whether minimally invasive surgery is superior to traditional surgery in the treatment of hepatolithiasis. The result of the study was: 1. The operative time (min:120.28 卤11.67 vs 141.36 卤13.52), intraoperative bleeding volume (ml:79.35 卤9.71 vs 146.34 卤12.25) and postoperative drainage tube retention time (d: 3.23 卤1.21 vs4.93 卤3.34) in the experimental group were shorter than those in the control group. The decrease of these indexes can reflect the safety of the operation. 2. The incidence of postoperative complications (0 vs 18.75%), the recurrence rate of stones (0 vs 21.87%) and the residual stone rate (6.25%vs 25.006.25%) in the experimental group were significantly lower than those in the control group (P0.05). The decline in these observational indicators is an assessment of therapeutic effectiveness. Conclusion: 1. The results showed that the operation time was short, the bleeding was less, the time of drainage tube indwelling was short, the incidence of postoperative complications was low, the recurrence rate of stone was small, and the rate of residual stone was low. Minimally invasive surgery was effective in the treatment of hepatolithiasis with a high safety index of 2. Minimally invasive surgery has some advantages in the treatment of hepatolithiasis, which should be paid enough attention to clinically, but it should be paid more attention to improve the skill of operation and avoid the special collateral injury of minimally invasive surgery.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4
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