腹腔镜联合胆道镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石的疗效及安全性比较

发布时间：2019-05-20 05:09

【摘要】：目的：分析在对于胆囊结石患者在实施治疗的过程中,通过对于患者进行腹腔镜联合胆道镜保胆取石手术和常规的腹腔镜胆囊切除术对于患者的治疗效果以及相关安全性的比较。方法：收集我院在2012.3月-2013.2月间收治的使用影像学方法进行确诊为胆囊结石的患者,患者的数量为80例。按照患者在临床手术治疗过程中对于患者使用的不同治疗方法,将所有的患者分为观察组以及对照组,每组患者在数量方面,均为40例。对照组患者使用常规的腹腔镜胆囊切除术(Laparoscopic cholecystectomy, LC)的方法实施治疗。观察组患者使用腹腔镜联合胆道镜的保胆取石术(Laparoscopic choledochoscopy-assisted removal of cholecys cithias, LRCL)对于患者实施治疗,对比两组的手术时间、术中出血量、术后肠蠕动恢复时间、术后饮食恢复时间、住院时间、住院费用、术后并发症发生率、不良反应发生率以及术后复发率。结果：实验组(保胆取石组)和对照组(腹腔镜胆囊切除组)均无中转开腹病例,均取得很好的治疗效果,无严重的并发症发生,保胆取石组与腹腔镜胆囊切除术组的比较,术中出血量少、术后并发症发生率低、不良反应发生率低,但手术时间稍长,两组患者的术后肠蠕动恢复时间、术后饮食恢复时间、住院时间、住院费用无统计学差异(P0.05),对保胆取石组进行相应的随访后我们发现,术后1年复查胆囊结石复发率为2.5%,术后2年复查胆囊结石复发率为5%,符合正常人群的胆囊结石患病率。。结论：腹腔镜联合胆道镜保胆取石术治疗胆囊结石,能够显著的降低患者的术中出血量、并发症以及术后不良反应等情况,不增加手术完成后的肠蠕动恢复时间、饮食恢复时间、住院时间、以及患者的治疗所需费用,是治疗胆囊结石的一种有效治疗手段,在理论及技术上安全、可行,符合微创治疗观念,保留了有功能的胆囊,提高了生活质量,满足了有保胆意识的病人,可以在有条件的医院中开展此技术。
[Abstract]:Objective: to analyze the course of treatment for patients with gallstone. The therapeutic effect and related safety of laparoscopic choledochoscopy combined with choledochoscope choledocholithotomy and conventional laparoscopic gallbladder resection were compared. Methods: 80 patients with gallstones were diagnosed by imaging from March 2012.3 to February 2013.The number of patients was 80. According to the different treatment methods used by the patients in the course of clinical operation, all the patients were divided into observation group and control group, and the number of patients in each group was 40 cases. The patients in the control group were treated with conventional laparoscopic Cholecystectomy (Laparoscopic cholecystectomy, LC). The patients in the observation group were treated with laparoscopic choledochoscopy (Laparoscopic choledochoscopy-assisted removal of cholecys cithias, LRCL). The operation time, the amount of bleeding during operation, the recovery time of intestinal peristalsis and the recovery time of diet between the two groups were compared. Length of stay, cost of hospitalization, incidence of postoperative complications, incidence of adverse reactions and recurrence rate. Results: there were no cases of conversion to laparotomy in the experimental group (choledocholithotomy group) and the control group (laparoscopic Cholecystectomy group). There were no serious complications in the experimental group (cholelithiasis group) and the control group (laparoscopic Cholecystectomy group). The amount of intraoperative bleeding was less, the incidence of postoperative complications was low, and the incidence of adverse reactions was low, but the operation time was a little longer. The recovery time of intestinal peristalsis, the recovery time of postoperative diet and the time of hospitalization in the two groups. There was no significant difference in hospitalization expenses (P 0.05). After the corresponding follow-up of cholelithiasis group, we found that the recurrence rate of gallstone was 2.5% in 1 year and 5% in 2 years after operation. Consistent with the prevalence of gallstones in the normal population.. Conclusion: laparoscopic choledochoscopy combined with choledochoscopy in the treatment of gallstones can significantly reduce the amount of intraoperative bleeding, complications and postoperative adverse reactions, and do not increase the recovery time of intestinal peristalsis after operation. Diet recovery time, hospitalization time and the cost of patients' treatment are an effective treatment for gallstones. It is safe and feasible in theory and technology, in line with the concept of minimally invasive treatment, and retains the functional gallbladder. This technology can be carried out in conditional hospitals by improving the quality of life and satisfying the patients with gallbladder awareness.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.42

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