胆囊结石并胆总管结石患者行微创手术和开腹手术的疗效比较
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摘要
目的比较微创手术、开腹手术治疗胆囊结石并胆总管结石的效果。方法胆囊结石并胆总管结石患者155例,依据胆总管结石直径分为A组(结石直径10～20mm)78例、B组(结石直径<10mm)77例。A组行微创手术38例,开腹手术40例;B组行微创手术46例,开腹手术31例。微创术式为内镜十二指肠乳头括约肌切开术/内镜十二指肠乳头球囊扩张术+腹腔镜胆囊切除术,开腹术式为胆囊切除+胆总管切开取石T管引流术。比较2组住院时间、手术时间、术中出血量、胆总管结石清除率及并发症发生情况。结果 A组行微创手术者手术时间[(104.23±37.70)min]较行开腹手术者[(181.08±34.19)min]短,术中出血量[(17.24±9.49)mL]较行开腹手术者[(90.25±51.35)mL]少(P<0.05),住院时间[(20.08±5.61)d]、结石清除率(94.7%)、并发症发生率(10.5%)与行开腹手术者[(17.55±6.81)d、100.0%、10.0%]比较差异无统计学意义(P>0.05);B组行微创手术者手术时间[(102.68±18.69)min]较行开腹手术者[(154.54±44.16)min]短,术中出血量[(15.67±10.94)mL]较行开腹手术者[(60.00±29.69)mL]少(P<0.05),住院时间[(16.59±7.11)d]、结石清除率(97.8%)、并发症发生率(2.2%)与行开腹手术者[(15.10±2.86)d、100.0%、0]比较差异无统计学意义(P>0.05)。结论对胆总管结石并胆囊结石并患者,行内镜十二指肠乳头括约肌切开术/内镜十二指肠乳头球囊扩张术+腹腔镜胆囊切除术可取得与胆囊切除+胆总管切开取石T管引流术相同的效果,且具有手术时间短、术中出血量少的优势。
Objective To compare the outcomes of minimally invasive operation versus traditional open surgery for common bile duct stones and gallbladder stones.Methods Totally 155 patients with common bile duct stones and gallbladder stones were divided into 78 patients with stone 10 to 20 mm in diameter(group A)and 77 patients with stone<10mm in diameter(group B)according to common bile duct stones diameter.In group A,38 patients were performed endoscopic duodenal papillary sphincter incision/endoscopic duodenal papillary balloon dilatation+laparoscopic cholecystectomy(EST/EPBD+LC)and 40 were performed open cholecystectomy+common bile duct incision with T-tube drainage(OC+OCHTD),while in group B,46 patients were performed EST/EPBD+LC and 31 were performed OC+ OCHTD.The hospital stay,operative time,intraoperative blood loss,stone clearance rate and complication incidence were compared.Results EST/EPBD+LC had shorter operative time((104.23±37.70)min)and less intraoperative blood loss((17.24±9.49)mL)compared with OC+OCHTD((181.08±34.19)min,(90.25±51.35)mL)(P<0.05),while there were no significant differences in hospital stay((20.08±5.61)d vs.(17.55±6.81)d),stone clearance rate(94.7% vs.100.0%)and incidence of complication(10.5% vs.10.0%)between two methods in group A(P>0.05).EST/EPBD+LC had shorter operative time((102.68±18.69)min)and less intraoperative blood loss((15.67±10.94)mL)compared with OC+OCHTD((154.54±44.16)min,(60.00±29.69)mL)(P<0.05),while there were no significant differences in hospital stay((16.59±7.11)d vs.(15.10±2.86)d),stone clearance rate(97.8%vs.100.0%),and incidence of complication(2.2%vs.0)between two methods in group B(P>0.05).Conclusion Both EST/EPBD+LC and OC+OCHTD are safe and effective for common bile stones and gallbladder stones,but the former has shorter operative time and less intraoperative blood loss than the latter.
Objective To compare the outcomes of minimally invasive operation versus traditional open surgery for common bile duct stones and gallbladder stones.Methods Totally 155 patients with common bile duct stones and gallbladder stones were divided into 78 patients with stone 10 to 20 mm in diameter(group A)and 77 patients with stone<10mm in diameter(group B)according to common bile duct stones diameter.In group A,38 patients were performed endoscopic duodenal papillary sphincter incision/endoscopic duodenal papillary balloon dilatation+laparoscopic cholecystectomy(EST/EPBD+LC)and 40 were performed open cholecystectomy+common bile duct incision with T-tube drainage(OC+OCHTD),while in group B,46 patients were performed EST/EPBD+LC and 31 were performed OC+ OCHTD.The hospital stay,operative time,intraoperative blood loss,stone clearance rate and complication incidence were compared.Results EST/EPBD+LC had shorter operative time((104.23±37.70)min)and less intraoperative blood loss((17.24±9.49)mL)compared with OC+OCHTD((181.08±34.19)min,(90.25±51.35)mL)(P<0.05),while there were no significant differences in hospital stay((20.08±5.61)d vs.(17.55±6.81)d),stone clearance rate(94.7% vs.100.0%)and incidence of complication(10.5% vs.10.0%)between two methods in group A(P>0.05).EST/EPBD+LC had shorter operative time((102.68±18.69)min)and less intraoperative blood loss((15.67±10.94)mL)compared with OC+OCHTD((154.54±44.16)min,(60.00±29.69)mL)(P<0.05),while there were no significant differences in hospital stay((16.59±7.11)d vs.(15.10±2.86)d),stone clearance rate(97.8%vs.100.0%),and incidence of complication(2.2%vs.0)between two methods in group B(P>0.05).Conclusion Both EST/EPBD+LC and OC+OCHTD are safe and effective for common bile stones and gallbladder stones,but the former has shorter operative time and less intraoperative blood loss than the latter.
引文
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[6]张利,罗辉,张荣春,等.经内镜逆行胰胆管造影术治疗胆总管切开取石及T管引流术后胆总管残余结石的临床观察[J].中华消化内镜杂志,2018,35(2):133-135.
[7]金峰,毛志海.影响胆囊结石合并胆总管结石手术治疗效果的因素分析[J].中国普通外科杂志,2013,22(5):667-670.
[8]熊慧芳,雷宇鹏,李国华,等.经内镜鼻胆管引流预防胆总管结石经内镜逆行性胰胆管造影术后胰腺炎和高淀粉酶血症的疗效[J].中华消化杂志,2017,34(5):342-344.
[9]陈素敏,任迎春,赵秋艳,等.金属支架置入联合鼻胆管引流对胆管癌患者ERCP术后胆管炎的预防作用[J].胃肠病学,2018,23(6):351-355.
[2]顾强,汪意清.腹腔镜胆囊切除联合胆总管切开取石T管引流与传统开腹手术近远期疗效对比研究[J].临床外科杂志,2017,24(10):799-800.
[3]GAO Y C,CHEN J,QIN Q,et al.Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones:a meta-analysis of randomized controlled trials[J].Medicine(Baltimore),2017,96(37):e7925.
[4]周长升,芶欣,苏正,等.腹腔镜与开腹胆总管切开取石加T管引流术治疗肝内外胆管结石的疗效比较[J].中华普通外科杂志,2018,33(3):228-231.
[5]范羿,范康川,梁旭康,等.腹腔镜内窥镜治疗胆总管结石两种术式的临床分析[J].中华肝胆外科杂志,2012,18(4):313-314.
[6]张利,罗辉,张荣春,等.经内镜逆行胰胆管造影术治疗胆总管切开取石及T管引流术后胆总管残余结石的临床观察[J].中华消化内镜杂志,2018,35(2):133-135.
[7]金峰,毛志海.影响胆囊结石合并胆总管结石手术治疗效果的因素分析[J].中国普通外科杂志,2013,22(5):667-670.
[8]熊慧芳,雷宇鹏,李国华,等.经内镜鼻胆管引流预防胆总管结石经内镜逆行性胰胆管造影术后胰腺炎和高淀粉酶血症的疗效[J].中华消化杂志,2017,34(5):342-344.
[9]陈素敏,任迎春,赵秋艳,等.金属支架置入联合鼻胆管引流对胆管癌患者ERCP术后胆管炎的预防作用[J].胃肠病学,2018,23(6):351-355.