微创保胆取石术与胆囊取出术对胆囊结石患者中长期生活水平的影响
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摘要
目的探究微创保胆取石术与取出术对胆囊结石患者中长期生活水平的影响.方法将2008年1月至2013年1月至三峡大学第二人民医院肝胆外科住院、接受胆囊微创手术(微创保胆取石术或微创胆囊取出术)并符合纳入标准的214例胆囊结石患者纳入研究,分为微创保胆组和微创取胆组,各107例;手术由同一位主任医师操作.术后半年、3 a、5 a对比2组患者胆囊、肝脏、胰腺并发症情况及LDQ功能性消化不良评分.结果术后半年2组胆囊、肝脏、胰腺并发症发生情差异无统计学意义(P>0.05),LDQ功能性消化不良评分微创保胆组高于微创取胆组(P<0.05).术后3 a、5 a 2组胆囊、肝脏、胰腺并发症发生情况有差异(P<0.05),LDQ功能性消化不良评分微创保胆组与微创取胆组无差异(P>0.05).结论从长远来看,病情较复杂胆囊结石患者对具体术式难以取舍时适宜采用微创取胆术治疗.
Objective To investigate the mid-and-long term impact of minimally invasive lithotomy and cholecystectomy on the living status of patients with cholelithiasis. Me thods From January 2008 to January 2013,214 cases who had received minimally invasive surgery in cholecyst(either minimally invasive lithotomy or minimally invasive cholecystectomy) and complied with study eligibility were recruited in the study. They were divided into minimally invasive lithotomy group and minimally invasive cholecystectomy group with 107 cases in each group. All the surgeries were performed by an experienced senior chief physician. Follow-up in half a year, 3 years and 5 years after surgery was conducted to evaluate the complications of cholecyst, liver and pancreas in patients,as well as their LDQ digestive function between the two groups. Re s ults There was no significant different in the complications of cholecyst, liver and pancreas in patients of two groups in 6 months after surgery(P >0.05).while, the LDQ digestive function was worse in patients receiving minimally invasive lithotomy group than in minimally invasive cholecystectomy group 6 months after surgery(P <0.05). In 3 years and 5 years after the surgery, evaluation on complications of cholecyst, liver and pancreas in both groups showed significant difference(P<0.05), however, the evaluation of LDQ digestive function showed no difference between the two groups(P >0.05). Conclusion From a long-term perspective, for patients with complex cholecystolithiasis,physicians may choose the minimally invasive cholecystectomy for better effects.
Objective To investigate the mid-and-long term impact of minimally invasive lithotomy and cholecystectomy on the living status of patients with cholelithiasis. Me thods From January 2008 to January 2013,214 cases who had received minimally invasive surgery in cholecyst(either minimally invasive lithotomy or minimally invasive cholecystectomy) and complied with study eligibility were recruited in the study. They were divided into minimally invasive lithotomy group and minimally invasive cholecystectomy group with 107 cases in each group. All the surgeries were performed by an experienced senior chief physician. Follow-up in half a year, 3 years and 5 years after surgery was conducted to evaluate the complications of cholecyst, liver and pancreas in patients,as well as their LDQ digestive function between the two groups. Re s ults There was no significant different in the complications of cholecyst, liver and pancreas in patients of two groups in 6 months after surgery(P >0.05).while, the LDQ digestive function was worse in patients receiving minimally invasive lithotomy group than in minimally invasive cholecystectomy group 6 months after surgery(P <0.05). In 3 years and 5 years after the surgery, evaluation on complications of cholecyst, liver and pancreas in both groups showed significant difference(P<0.05), however, the evaluation of LDQ digestive function showed no difference between the two groups(P >0.05). Conclusion From a long-term perspective, for patients with complex cholecystolithiasis,physicians may choose the minimally invasive cholecystectomy for better effects.
引文
[1]吴泰璜,苏忠学,吴亚光.实用肝胆外科学[M].第4版.广州:世界图书出版广东有限公司,2013:260.
[2]曲强,田锋.胆囊结石的处理现状及治疗新策略[J].国际外科学杂志,2016,17(1):4-7.
[3]王惠群,傅贤波.我国内镜微创保胆取石术的发展现状分析[J].中国微创外科杂志,2010,15(6):481-485.
[4]KOGANTI DEEPIKA,DOANE STEPHEN,PALAZZO FRANCESCO,et al.Cholecystotomy with stone retrieval:A novel approach for the management of gallstone Ileus[J].American Surgeon,2017,83(1):E30-E32.
[5]TARANTINO GIUSEPPE,MAGISTRI PAOLO,BALLARIN ROBERTO,et al.Surgery in biliary lithiasis:From the traditional“Open”approach to laparoscopy and the“Rendezvous”technique[J].Hepatobiliary&Pancreatic Diseases International,2017,16(6):595-601.
[6]王青,杨平,王成果,等.胆囊结石分级分期治疗策略:附441例保胆手术经验总结与体会[J].中国内镜杂志,2014,20(3):225-229.
[7]YE J F,WU X M,ZHANG B Z,et al.Recommendationsfor EASL clinical practice guidelines on the prevention,diagnosisand therapy of gallstones(2016)[J].J Clin Hepatol,2016,32(8):1446-1449.
[8]刘京山.内镜微创保胆手术指南(2015版)[J].中国内镜杂志,2016,11(2):114-113.
[9]吴泰璜.实用肝胆外科学[M].第4版.北京:世界图书出版公司北京公司,2013:340-345.
[10]LAKYOV L,RADONAK J,J VAJ,et al.Biliary ileus--a rare complication of cholecystolithiasis[J].Rozhl Chir,2007,86(10):526-532.
[11]HIROBE-JAHN S,HARSCH S,RENNER O,et al.Association of FXR gene variants with cholelithiasis[J].Clin Res Hepatol Gastroenterol,2015,39(1):68-79.
[12]JARUFE N,SOTO P,AHUMADA V,et al.Laparoscopic versus open distal pancreatectomy:Comparative analysis of cinical outcomes at a single institution[J].Surg Laparosc Endosc Percutan Tech,2018,28(1):62-68.
[13]李潇娴,朱江帆,忻颖.不同人群对胆囊切除手术方式的选择[J].中国微创外科杂志,2012,12(7):644-646.
[14]刘允怡,赖俊雄,刘晓欣.胆囊切除术技术及观念变迁给予我们的启示[J].中国实用外科杂志,2015,35(9):917-919.
[15]孙向宇.胆总管结石合并胆囊结石微创治疗进展[J].中国中西医结合外科杂志,2016,23(3):306-309.
[16]CHUN K S,HAN H S,YOON Y S,et al.Overcoming the difficulties encountered when performing laparoscopic cholecystectomy:review of over one thousand laparoscopic cholecystectomies[J].Hepatogastroenterology,2010,57(3):398-402.
[17]CHUN KWANG-SIK,HAN HO-SEONG,YOON YOOSEOK,et al.Gallbladder hypoplasia,a congenital abnormality of the gallbladder:A case report[J].Am J Case Rep,2017,18(2):1320-1324.
[18]PEI YIN,MIN WANG,RENYI QIN,et al.Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis:a cohort study of 211 cases[J].Surg Endosc,2017,31(8):3219-3226.
[19]NAOTO KURODA,MITSUO OKADA,MAKOTO TOI,et al.Lipomatous pseudohypertrophy of the pancreas:Further evidence of advanced hepatic lesion as the pathogenesis[J].Pathology International,2003,53(2):98-101.
[20]ZHAO R H,YUE B F,NI J Y,et al.Application of an artificial neural network in chromatography-retention behavior prediction and pattern recognition[J].Chemometrics and Intelligent Laboratory Systems,1999,45(1):163-170.
[21]CHOI Y S,DO J H,SUH S W,et al.Risk factors for the late development of common bile duct stones after laparoscopic cholecystectomy[J].Surg Endosc,2017,31(11):4587-4593.
[22]RONG-CHIN LOA,WEN-LIN HUANGA,YU-MING FANB.Evaluation of bile reflux in HIDA images based on fluid mechanics[J].Computers in Biology and Medicine,2015,60(5):51-65.
[23]TOMOHIKO ADACHI,YOSHITSUGU TAJIMA,TAMOTSU KUROKI,et al.Bile-reflux into the pancreatic ducts is associated with the development of intraductal papillary carcinoma in hamsters[J].Journal of Surgical Research,2006,136(1):106-111.
[24]KOWAL J M,HAANES K A,CHRISTENSEN N M,et al.Bile acid effects are mediated by ATP release and purinergic signalling in exocrine pancreatic cells[J].Cell Communication and Signaling,2015,13(7):28.
[25]HELLMIG S,KATSOULIS S,FOLSCH U.Symptomatic cholecystolithiasis after laparoscopic cholecystectomy[J].Surgical Endoscopy,2004,18(2):347.
[26]TAKADA T,YASUDA H,UCHIYAMA K,et al.Relationship of cholecystectomy and detachment of the common bile duct to chronic bile duct dilation[J].Hepatogastroenterology,1992,39(5):470-474.
[27]刘融,何德山,党铁成,等.腹腔镜胆囊切除术后胆总管扩张情况的观察[J].中国现代普通外科进展,2016,19(12):925-927.
[2]曲强,田锋.胆囊结石的处理现状及治疗新策略[J].国际外科学杂志,2016,17(1):4-7.
[3]王惠群,傅贤波.我国内镜微创保胆取石术的发展现状分析[J].中国微创外科杂志,2010,15(6):481-485.
[4]KOGANTI DEEPIKA,DOANE STEPHEN,PALAZZO FRANCESCO,et al.Cholecystotomy with stone retrieval:A novel approach for the management of gallstone Ileus[J].American Surgeon,2017,83(1):E30-E32.
[5]TARANTINO GIUSEPPE,MAGISTRI PAOLO,BALLARIN ROBERTO,et al.Surgery in biliary lithiasis:From the traditional“Open”approach to laparoscopy and the“Rendezvous”technique[J].Hepatobiliary&Pancreatic Diseases International,2017,16(6):595-601.
[6]王青,杨平,王成果,等.胆囊结石分级分期治疗策略:附441例保胆手术经验总结与体会[J].中国内镜杂志,2014,20(3):225-229.
[7]YE J F,WU X M,ZHANG B Z,et al.Recommendationsfor EASL clinical practice guidelines on the prevention,diagnosisand therapy of gallstones(2016)[J].J Clin Hepatol,2016,32(8):1446-1449.
[8]刘京山.内镜微创保胆手术指南(2015版)[J].中国内镜杂志,2016,11(2):114-113.
[9]吴泰璜.实用肝胆外科学[M].第4版.北京:世界图书出版公司北京公司,2013:340-345.
[10]LAKYOV L,RADONAK J,J VAJ,et al.Biliary ileus--a rare complication of cholecystolithiasis[J].Rozhl Chir,2007,86(10):526-532.
[11]HIROBE-JAHN S,HARSCH S,RENNER O,et al.Association of FXR gene variants with cholelithiasis[J].Clin Res Hepatol Gastroenterol,2015,39(1):68-79.
[12]JARUFE N,SOTO P,AHUMADA V,et al.Laparoscopic versus open distal pancreatectomy:Comparative analysis of cinical outcomes at a single institution[J].Surg Laparosc Endosc Percutan Tech,2018,28(1):62-68.
[13]李潇娴,朱江帆,忻颖.不同人群对胆囊切除手术方式的选择[J].中国微创外科杂志,2012,12(7):644-646.
[14]刘允怡,赖俊雄,刘晓欣.胆囊切除术技术及观念变迁给予我们的启示[J].中国实用外科杂志,2015,35(9):917-919.
[15]孙向宇.胆总管结石合并胆囊结石微创治疗进展[J].中国中西医结合外科杂志,2016,23(3):306-309.
[16]CHUN K S,HAN H S,YOON Y S,et al.Overcoming the difficulties encountered when performing laparoscopic cholecystectomy:review of over one thousand laparoscopic cholecystectomies[J].Hepatogastroenterology,2010,57(3):398-402.
[17]CHUN KWANG-SIK,HAN HO-SEONG,YOON YOOSEOK,et al.Gallbladder hypoplasia,a congenital abnormality of the gallbladder:A case report[J].Am J Case Rep,2017,18(2):1320-1324.
[18]PEI YIN,MIN WANG,RENYI QIN,et al.Intraoperative endoscopic nasobiliary drainage over primary closure of the common bile duct for choledocholithiasis combined with cholecystolithiasis:a cohort study of 211 cases[J].Surg Endosc,2017,31(8):3219-3226.
[19]NAOTO KURODA,MITSUO OKADA,MAKOTO TOI,et al.Lipomatous pseudohypertrophy of the pancreas:Further evidence of advanced hepatic lesion as the pathogenesis[J].Pathology International,2003,53(2):98-101.
[20]ZHAO R H,YUE B F,NI J Y,et al.Application of an artificial neural network in chromatography-retention behavior prediction and pattern recognition[J].Chemometrics and Intelligent Laboratory Systems,1999,45(1):163-170.
[21]CHOI Y S,DO J H,SUH S W,et al.Risk factors for the late development of common bile duct stones after laparoscopic cholecystectomy[J].Surg Endosc,2017,31(11):4587-4593.
[22]RONG-CHIN LOA,WEN-LIN HUANGA,YU-MING FANB.Evaluation of bile reflux in HIDA images based on fluid mechanics[J].Computers in Biology and Medicine,2015,60(5):51-65.
[23]TOMOHIKO ADACHI,YOSHITSUGU TAJIMA,TAMOTSU KUROKI,et al.Bile-reflux into the pancreatic ducts is associated with the development of intraductal papillary carcinoma in hamsters[J].Journal of Surgical Research,2006,136(1):106-111.
[24]KOWAL J M,HAANES K A,CHRISTENSEN N M,et al.Bile acid effects are mediated by ATP release and purinergic signalling in exocrine pancreatic cells[J].Cell Communication and Signaling,2015,13(7):28.
[25]HELLMIG S,KATSOULIS S,FOLSCH U.Symptomatic cholecystolithiasis after laparoscopic cholecystectomy[J].Surgical Endoscopy,2004,18(2):347.
[26]TAKADA T,YASUDA H,UCHIYAMA K,et al.Relationship of cholecystectomy and detachment of the common bile duct to chronic bile duct dilation[J].Hepatogastroenterology,1992,39(5):470-474.
[27]刘融,何德山,党铁成,等.腹腔镜胆囊切除术后胆总管扩张情况的观察[J].中国现代普通外科进展,2016,19(12):925-927.