腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效观察
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摘要
目的评价腹腔镜联合胆道镜经胆囊管治疗胆总管结石的疗效。方法回顾性分析2012年1月至2014年9月在广东医学院附属福田医院治疗的195例胆总管结石患者,按照术式分为腹腔镜联合术中胆道镜经胆囊管胆道探查取石术(LTCBDE)组(43例)、腹腔镜胆道探查"T"管引流(LCBDE)组(65例)和剖腹胆囊切除、胆总管探查取石、"T"管引流术(OCBD)组(87例)。比较三组患者手术时间、术中出血量、术后肛门排气时间、视觉模拟评分法(VAS)评分、并发症发生率,以及三组治疗前后CRP、PA、TBIL和ALT水平的变化。结果 3组患者均成功进行手术,LTCBDE组除手术时间比OCBD组长外,术中出血量、术后VAS评分、肛门排气时间、术后住院时间和并发症明显少于LCBDE和OCBD组(P<0.001)。LTCBDE组的并发症发生率为4.7%,明显低于LCBDE组的15.4%和OCBD组的23.0%,差异有统计学意义(P<0.05)。治疗后,三组的CRP、TBIL和ALT水平比治疗前明显降低(P<0.001),而PA水平比治疗前明显升高(P<0.001)。LTCBDE组的降低和升高水平比其余两组更为明显(P<0.001)。结论 LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,是一种有效、安全及经济的术式。
Objective To evaluate the efficacy of cho1 edochoscope combined with laparoscopy for patients with common bile duct stones. Methods The patients with common bile duct stones in our hospital(195 cases), from January 2012 to September 2014 were retrospectively studied. Of them,43 cases underwent laparoscopic trancystic common bile duct exploration(LTCBDE group), 65 cases received laparoscopic common bile duct exploration(LCBDE group).and 87 cases were treated with open-laparotomy common bile duct exploration.(OCBD group) in accordance with the modus operandi.The operative time, blood loss, postoperative anal exhaust time,.visual analog scale(VAS) score and incidence of complications were evaluated. The levels of CRP,.PA,.TBIL and ALT were measured before and after the treatment. Results All patients were successful operated. Compared with those indics in LCBDE group and OCBD group, the blood loss,.postoperative VAS score, anal exhaust time,.hospital stay and complications in LTCBDE group were significantly decreased or shortened,except for the operation time(P<0.001). The complication rate of the LTCBDE group was 4.7%, and15.4% in the LCBDE group,.and 23.0% in the laparotomy group..The complications rates in the LTCBDE group was significantly lower than the other two groups(P<0.05). After treatment, the levels of CRP,.TBIL and ALT were significantly reduced(P <0.001),.while the PA levels appeared to increase(P <0.001)...The lowering and raising levels of LTCBDE group were more significant,compared with the other two groups(P <0.001). Conclusion LTCBDE has small trauma, less complications, low cost, high postoperative quality of life, and can be regarded as aseffective, safe and economic operation.
Objective To evaluate the efficacy of cho1 edochoscope combined with laparoscopy for patients with common bile duct stones. Methods The patients with common bile duct stones in our hospital(195 cases), from January 2012 to September 2014 were retrospectively studied. Of them,43 cases underwent laparoscopic trancystic common bile duct exploration(LTCBDE group), 65 cases received laparoscopic common bile duct exploration(LCBDE group).and 87 cases were treated with open-laparotomy common bile duct exploration.(OCBD group) in accordance with the modus operandi.The operative time, blood loss, postoperative anal exhaust time,.visual analog scale(VAS) score and incidence of complications were evaluated. The levels of CRP,.PA,.TBIL and ALT were measured before and after the treatment. Results All patients were successful operated. Compared with those indics in LCBDE group and OCBD group, the blood loss,.postoperative VAS score, anal exhaust time,.hospital stay and complications in LTCBDE group were significantly decreased or shortened,except for the operation time(P<0.001). The complication rate of the LTCBDE group was 4.7%, and15.4% in the LCBDE group,.and 23.0% in the laparotomy group..The complications rates in the LTCBDE group was significantly lower than the other two groups(P<0.05). After treatment, the levels of CRP,.TBIL and ALT were significantly reduced(P <0.001),.while the PA levels appeared to increase(P <0.001)...The lowering and raising levels of LTCBDE group were more significant,compared with the other two groups(P <0.001). Conclusion LTCBDE has small trauma, less complications, low cost, high postoperative quality of life, and can be regarded as aseffective, safe and economic operation.
引文
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[9]郭伟,韩威,金岚,等.腹腔镜联合术中经胆囊管胆道镜辅助胆管探查取石术:附546例报告[J].外科理论与实践,2011,16(4):359-361.
[10]王聪,谷昊.腹腔镜下经胆囊管胆道探查术与腹腔镜下胆道探查“T”管引流治疗继发性肝外胆管结石比较[J].新疆医科大学学报,2014,37(10):1318-1320.
[11]Varben O,Assimos D,Passman C,et al.Laparoseopic common bile duet exploration and holmium laser lithotripsy:a novel approach to the management of common bile duct stones[J].Surg Endosc,2010,24(7):1759-1764.
[12]韩威,张忠涛,李建设,等.腹腔镜联合术中胆道镜经胆囊管胆道探查取石技巧[J].腹腔镜外科杂志,2010,30(3):200-202.
[13]Berci G,Morgenstem L.Laparoscopic management of common bile duct stones:A multi-institutional SAGES study[J].Surg Endosc,1994,8(10):1168-1175.
[14]Charles M,Ferguson MD.Laparoscopic common bile duct exploration practical application[J].Arch Surg,1998,133(4):448-451.
[15]Warschkow R,Ukegjini K,Tarantino I,et a1.Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery[J].J Hepatobiliary Panereat Sci,2012,19(4):492-500.
[2]Savita KS,Bhartia VK.Laparoscopic CBD Exploration[J].Indian J Surg,2010,72(5):395-399.
[3]Fletcher DR.Percutaneous(1aparoscopic)cholecystectomy and exploration of the common bile duct:the common bile duct stone reclaimed for the surgeon[J].Aust NZJ Surg,1991,61(11):814-815.
[4]Yamazaki M,Yasuda H,Tsukamoto S,et al.Primary closure of the common bile duct in open laparotomy for common bile duct stones[J].J Hepatobiliary Pancreat Surg,2006,13(5):398-402.
[5]殷子,徐康,孙健,等.腹腔镜胆总管探查取石术后一期缝合与T管引流随机对照试验的系统评价和meta-分析[J].岭南现代临床外科,2011,11(6):404-412.
[6]Chan HH,Wang EM,Sun MS,et a1.Linear echoendoscopeguided ERCP for the diagnosis of occult common bile duet stones[J].BMC Gastroenterol,2013,13(1):44.
[7]Chiarugi M,Galatioto C,Decanini L,et al.Laparoscopic transcystic exploration for single-stage management of common duct stones and acute cholecystitis[J].Surg Endosc,2012,26(1):124-129.
[8]Masoni L,Marl FS,Pietropaolo V,et al.Laparoscopic treatment for unsuspected common bile duct stones by transcystic sphincter of Oddi pneumatic balloon dilation and pressure-washing technique[J].World J Surg,2013,37(6):1258-1262.
[9]郭伟,韩威,金岚,等.腹腔镜联合术中经胆囊管胆道镜辅助胆管探查取石术:附546例报告[J].外科理论与实践,2011,16(4):359-361.
[10]王聪,谷昊.腹腔镜下经胆囊管胆道探查术与腹腔镜下胆道探查“T”管引流治疗继发性肝外胆管结石比较[J].新疆医科大学学报,2014,37(10):1318-1320.
[11]Varben O,Assimos D,Passman C,et al.Laparoseopic common bile duet exploration and holmium laser lithotripsy:a novel approach to the management of common bile duct stones[J].Surg Endosc,2010,24(7):1759-1764.
[12]韩威,张忠涛,李建设,等.腹腔镜联合术中胆道镜经胆囊管胆道探查取石技巧[J].腹腔镜外科杂志,2010,30(3):200-202.
[13]Berci G,Morgenstem L.Laparoscopic management of common bile duct stones:A multi-institutional SAGES study[J].Surg Endosc,1994,8(10):1168-1175.
[14]Charles M,Ferguson MD.Laparoscopic common bile duct exploration practical application[J].Arch Surg,1998,133(4):448-451.
[15]Warschkow R,Ukegjini K,Tarantino I,et a1.Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery[J].J Hepatobiliary Panereat Sci,2012,19(4):492-500.