三种术式治疗肝外胆管结石的临床对比分析

发布时间：2018-10-24 06:17

【摘要】：目的:肝外胆管结石作为一种常见疾病,目前在临床上治疗该疾病应用最广泛的有以下三种:1、传统开腹胆总管切开取石术。2、十二指肠内镜下乳头括约肌切开取石术(EST)3、腹腔镜联合胆道镜术。通过对比多个指标,对这3种不同治疗肝外胆管结石的术式进行总结,最终为临床工作提供可靠的参考依据。方法:回顾自2014年1月至2014年12月厦门大学附属中山医院肝胆外科收治的肝外胆管结石患者98例。分为传统开腹手术组(A组)、十二指肠内镜下乳头括约肌切开取石术(EST)组(B组)、腹腔镜联合胆道镜组手术组(C组),分别为31、45、22。主要比较①手术时间、②术中出血量、③胃肠道功能恢复时间、④住院时间、⑤住院总费用、⑥并发症发生率、⑦手术成功率、⑧残石率这8个方面。结果:经过对比分析,内镜下十二指肠乳头括约肌切开取石术组(EST)(B组)在术后并发症发生率、手术成功率以及残石率上相比于腹腔镜联合胆道镜组(C组)、传统开腹手术组(A组)具有显著差异(P0.05),其余两组相比无显著差异(P0.05)。手术时间(min)腹腔镜联合胆道镜手术组(128.95±9.26),传统开腹手术组(131.52±8.15),无显著差异(P0.05),内镜下十二指肠乳头括约肌切开取石术组时间最短(97.42±15.16),与其他两组相比具有显著差异(P0.05)。术中出血量(ml),腹腔镜联合胆道镜手术组(20.71±4.21)、EST组最少(14.71±3.93),无显著差异(P0.05),传统开腹手术组最多(104.68±9.99),与其他组均具有显著差异(P0.05)。胃肠道功能恢复时间:三组对比,传统开腹手术组腹腔镜联合胆道镜手术组EST组,三组间均具有显著差异(P0.05)。住院时间及住院总费用与胃肠道功能恢复时间具有相同的趋势,传统开腹手术组腹腔镜联合胆道镜手术组EST组,三组间均具有显著差异(P0.05)。结论:腹腔镜联合胆道镜是治疗肝外胆管结石的新型微创治疗方式,与传统开腹手术相比在术中出血量明显减少、术后胃肠功能恢复时间、住院时间明显缩短及住院总费用明显降低;与内镜下十二指肠乳头括约肌切开取石术相比,在术后并发症发生率、残石率上显著降低、手术成功率提高。因此,腹腔镜联合胆道镜治疗肝外胆管结石是较其他两种方式更安全、有效、可行的治疗方法。
[Abstract]:Objective: as a common disease, extrahepatic bile duct stones, At present, the most widely used in the treatment of this disease are as follows: 1. Traditional open choledocholithotomy. 2. Endoscopic duodenal sphincterotomy (EST) 3, laparoscopy combined with choledochoscopy. By comparing several indexes, this paper summarizes the three different operative methods of treating extrahepatic cholelithiasis, and finally provides reliable reference for clinical work. Methods: from January 2014 to December 2014, 98 patients with extrahepatic bile duct calculi were treated in Zhongshan Hospital, Xiamen University. The patients were divided into traditional laparotomy group (group A), endoscopic sphincterotomy of duodenal sphincterotomy (EST) group) and laparoscopic combined choledochoscopy group (group C). The operative time, intraoperative bleeding volume, gastrointestinal function recovery time, hospital stay time, total hospitalization cost, complication rate, operative success rate, and residual stone rate were compared in 8 aspects, including 1 operation time, 2 intraoperative bleeding volume, 3 gastrointestinal function recovery time, 4 hospital stay time, 5 total hospitalization cost, 6 complications rate, 7 surgical success rate and 8 residual stone rate. Results: the incidence of postoperative complications in the endoscopic sphincterotomy group (EST) (B group) was analyzed. Compared with the laparoscopy combined with choledochoscope group (group C), the traditional open surgery group (group A) had significant difference (P0.05), while the other two groups had no significant difference (P0.05). (min) laparoscopy combined with choledochoscope operation group (128.95 卤9.26), traditional open surgery group (131.52 卤8.15), there was no significant difference (P0.05), endoscopic sphincterotomy group (97.42 卤15.16), compared with the other two groups have significant difference (P0.05). The amount of intraoperative bleeding in (ml), laparoscopy combined with choledochoscope group (20.71 卤4.21), EST) was the least (14.71 卤3.93), there was no significant difference (P0.05), the traditional laparotomy group was the most (104.68 卤9.99), there was significant difference with other groups (P0.05). Gastrointestinal function recovery time: compared with the three groups, the traditional laparoscopy combined with choledochoscopy group EST group, the three groups were significantly different (P0.05). The time of hospitalization and total cost of hospitalization had the same trend with the recovery time of gastrointestinal function. There were significant differences among the three groups in the traditional open operation group combined with choledochoscope group EST group (P0.05). Conclusion: laparoscopy combined with choledochoscope is a new minimally invasive method for the treatment of extrahepatic cholelithiasis. Compared with endoscopic sphincterotomy, the incidence of postoperative complications and residual stone rate were significantly decreased, and the success rate of operation was higher than that of endoscopic sphincterotomy. Therefore, laparoscopy combined with choledochoscope is a more safe, effective and feasible method than the other two methods in the treatment of extrahepatic bile duct stones.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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