三镜结合保胆取石在胆囊结石合并胆总管结石中的应用

发布时间：2019-05-21 14:58

【摘要】：目的探讨应用腹腔镜、十二指肠镜、胆道镜三镜联合保胆取石技术治疗胆囊结石合并胆总管结石的临床疗效和可行性,探索胆石病新的微创治疗方式。方法收集2010年1月至2015年4月广西医科大学第一附属医院普通外科收治的52例术前已确诊为胆囊结石合并胆总管结石患者。52例患者均一期行ERCP诊疗术,二期22例患者行微创保胆取石术(EMIC组),30例患者行腹腔镜胆囊切除(LC组)。比较两组患者手术时间、术中出血量、术后肛门排气时间、术后住院时间。门诊及电话随访,对两组患者术后胆总管结石复发情况,腹痛、腹泻、腹胀、消化不良等不适症状以及EMIC组胆囊结石复发情况等进行调查分析。结果两组患者均在腔镜下顺利完成,无中转开腹。两组患者的术前一般资料,术后排气时间及住院时间无统计学差异(P0.05)。EMIC组手术时间、术中出血少于LC组(P0.05)。术后随访发现LC组4例胆总管结石复发,复发率为13.3%,EMIC组未见胆总管结石复发,1例胆囊结石复发。术后半年内出现腹痛、腹泻、腹胀、消化不良等不适症状,LC组17例,EMIC组3例,差异有统计学意义(P0.05)。1年以后出现腹痛、腹泻、腹胀、消化不良等不适症状,LC组10例,EMIC组2例,差异具有统计学意义(P0.05)。结论结合所观察指标结果,我们认为三镜结合保胆取石治疗胆囊结石合并胆总管结石降低手术风险和手术难度,术后短期胆囊结石及胆总管结石复发率低,安全可行,同时保留了胆囊,提高了患者的生活质量。
[Abstract]:Objective to investigate the clinical effect and feasibility of laparoscopy, duodenoscopy and choledochoscopy combined with choledocholithiasis in the treatment of gallstones complicated with choledocholithiasis, and to explore a new minimally invasive treatment of cholelithiasis. Methods from January 2010 to April 2015, 52 patients with gallstone complicated with choledocholithiasis were diagnosed before operation in the first affiliated Hospital of Guangxi Medical University. All 52 patients underwent ERCP in one stage. 22 patients underwent minimally invasive choledocholithotomy (EMIC group) and 30 patients underwent laparoscopic gallbladder resection (LC group). The operation time, intraoperative blood loss, postoperative anal exsufflation time and postoperative hospitalization time were compared between the two groups. The recurrence of choledocholithiasis, abdominal pain, diarrhea, abdominal distension, dyspepsia and the recurrence of cholelithiasis in EMIC group were investigated and analyzed. Results both groups were successfully completed under endoscopic surgery without conversion to laparotomy. There was no significant difference in preoperative general data, postoperative exhaust time and hospitalization time between the two groups (P 0.05). The operation time and intraoperative bleeding in). EMIC group were less than those in LC group (P 0.05). The recurrence rate of choledocholithiasis was 13.3% in LC group. No recurrence of choledocholithiasis and 1 recurrence of cholelithiasis were found in EMIC group. Abdominal pain, diarrhea, abdominal distension, dyspepsia and other uncomfortable symptoms occurred within half a year after operation, 17 cases in LC group and 3 cases in EMIC group, the difference was statistically significant (P 0.05). Abdominal pain, diarrhea, abdominal distension, dyspepsia and other uncomfortable symptoms occurred one year later. There were 10 cases in LC group and 2 cases in EMIC group, the difference was statistically significant (P 0.05). Conclusion combined with the results of the observed indexes, we think that the treatment of cholelithiasis complicated with choledocholithiasis with three mirrors and choledocholithiasis reduces the risk and difficulty of operation, and the recurrence rate of short-term gallstones and choledocholithiasis after operation is low, safe and feasible. At the same time, the gallbladder was preserved and the quality of life of the patients was improved.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.4

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