内镜保胆取息肉术与腹腔镜胆囊切除术治疗胆固醇性息肉的临床对比
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摘要
目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。
Objective To investigate the efficacy of endoscopic minimally invasive polypectomy with gallbladder preservation for cholesterol polypoid lesion of gallbladder(PLG). Methods The clinical data of 395 pathologically diagnosed cholesterol PLG patients in Xinjiang Military District Hospital from Jan. 2012 to Jan. 2017 was retrospectively analyzed. Among them, 216 cases underwent endoscopic minimally invasive polypectomy with gallbladder preservation, and 179 cases underwent laparoscopic cholecystectomy(LC). The perioperative indexes, postoperative complication incidence, and the long-term efficacy were compared between the two groups. Results The general data before operation was comparable between two groups(P>0.05). The operation duration [58(52, 67)min vs 59(56, 70) min], bleeding volume [(12.9±5.2) m L vs(16.6±4.7) m L], postoperative venting time [(17.3±5.3) h vs(21.0±3.8) h], ambulation time [8(6, 15) h vs 12(8, 19) h], hospitalization duration [(6.9±1.5) d vs(7.3±1.3) d], abdominal pain and diarrhea incidence(1.39% vs 6.15%) and total complication incidence(3.24% vs 12.85%) in the endoscopic minimally invasive polypectomy with gallbladder preservation group were all less than those in the LC group(Z/χ2:-2.195, 7.262, 7.953,-6.410, 2.330, 4.749, 10.988; all P<0.05). Follow-up ended in Jan. 2018, the follow-up time was 12 to 72 months, and the median follow-up time was 41 months. The rate of follow-up loss was 9.26%(20/216) in the endoscopic minimally invasive polypectomy with gallbladder preservation group and 8.94%(16/179) in the LC group. The recurrence rate was 6.63%(13/196) in the endoscopic minimally invasive polypectomy with gallbladder preservation. The incidence of intrahepatic and exprahepatic bile duct stones in the LC group was 1.23%(2/163). Conclusion For patients whose PLG may be cholesterol and have surgical indications or at the edge of indications, endoscopic minimally invasive polypectomy with gallbladder preservation is preferred.
Objective To investigate the efficacy of endoscopic minimally invasive polypectomy with gallbladder preservation for cholesterol polypoid lesion of gallbladder(PLG). Methods The clinical data of 395 pathologically diagnosed cholesterol PLG patients in Xinjiang Military District Hospital from Jan. 2012 to Jan. 2017 was retrospectively analyzed. Among them, 216 cases underwent endoscopic minimally invasive polypectomy with gallbladder preservation, and 179 cases underwent laparoscopic cholecystectomy(LC). The perioperative indexes, postoperative complication incidence, and the long-term efficacy were compared between the two groups. Results The general data before operation was comparable between two groups(P>0.05). The operation duration [58(52, 67)min vs 59(56, 70) min], bleeding volume [(12.9±5.2) m L vs(16.6±4.7) m L], postoperative venting time [(17.3±5.3) h vs(21.0±3.8) h], ambulation time [8(6, 15) h vs 12(8, 19) h], hospitalization duration [(6.9±1.5) d vs(7.3±1.3) d], abdominal pain and diarrhea incidence(1.39% vs 6.15%) and total complication incidence(3.24% vs 12.85%) in the endoscopic minimally invasive polypectomy with gallbladder preservation group were all less than those in the LC group(Z/χ2:-2.195, 7.262, 7.953,-6.410, 2.330, 4.749, 10.988; all P<0.05). Follow-up ended in Jan. 2018, the follow-up time was 12 to 72 months, and the median follow-up time was 41 months. The rate of follow-up loss was 9.26%(20/216) in the endoscopic minimally invasive polypectomy with gallbladder preservation group and 8.94%(16/179) in the LC group. The recurrence rate was 6.63%(13/196) in the endoscopic minimally invasive polypectomy with gallbladder preservation. The incidence of intrahepatic and exprahepatic bile duct stones in the LC group was 1.23%(2/163). Conclusion For patients whose PLG may be cholesterol and have surgical indications or at the edge of indications, endoscopic minimally invasive polypectomy with gallbladder preservation is preferred.
引文
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[6]王成方.胆囊息肉恶变的危险因素及手术指征分析[D].南开大学,2016.
[7]费翔,罗渝昆,焦子育,等.胆囊息肉样病变超声造影动脉期血管增强模式与息肉性质及大小的相关性[J].中华医学超声杂志(电子版),2017,14(7):538-543.
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[9]吴庆华,包皙婷,孔雷,等.使用常规器械经脐入路腹腔镜胆囊切除术491例报告[J].肝胆胰外科杂志,2016,28(4):265-269.
[10]杨澎,朱宇.保胆取石术治疗胆囊结石203例回顾性研究[J].肝胆胰外科杂志,2018,30(1):58-61.
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[13]郭绍红, Maria Coats, Sami M Shimi.胆囊切除术与消化道癌症的风险:一项系统性综述[J].中国微创外科杂志, 2017,17(1):27-32.
[14]于文涛,吴硕东,于晓鹏.腹腔镜联合胆囊镜胆囊息肉摘除术的临床应用[J].中华普通外科杂志, 2016, 31(11):911-913.
[15]王辉华,陈勇,李江华.微创内镜保胆术与腹腔镜胆囊切除术治疗胆囊息肉疗效比较[J].海南医学, 2016, 27(15):2206-2207.
[16]张蔚,薛皓皓,李雯,等.腹腔镜内镜微创保胆术治疗胆囊息肉的meta分析[J].中国医科大学学报, 2016, 45(11):1013-1016.
[17]王亚峰.腹腔镜微创保胆术治疗胆囊息肉的临床效果观察[J].中国医药指南, 2017, 15(24):164-165.
[18]刘永茂,李之令,刘江伟,等.微创保胆术后胆囊结石、息肉复发相关因素分析[J].山东医药, 2017, 57(23):94-96.
[19]刘玉翔,叶昱坪.腹腔镜联合胆道镜保胆取石术后预防胆囊结石复发的方法[J].中国实用医刊, 2017, 44(2):62-64.
[2]颜特,戴东.探讨胆囊息肉患者的临床诊治进展[J].医学信息,2016,29(5):22-23.
[3]刘京山.内镜微创保胆手术指南(2015版)[J].中国内镜杂志,2016,22(2):113-114.
[4]卢昊,刘全达.《2017年欧洲多学会联合指南:胆囊息肉管理和随访》摘译[J].临床肝胆病杂志,2017,33(6):1051-1055.
[5]潘鋆.胆囊息肉样病变临床病理学特征的回顾性研究[D].浙江大学,2015.
[6]王成方.胆囊息肉恶变的危险因素及手术指征分析[D].南开大学,2016.
[7]费翔,罗渝昆,焦子育,等.胆囊息肉样病变超声造影动脉期血管增强模式与息肉性质及大小的相关性[J].中华医学超声杂志(电子版),2017,14(7):538-543.
[8]严稳开.高频超声联合多普勒超声诊断良性胆囊息肉样病变的临床应用价值研究[J].临床和实验医学杂志,2016,15(12):1224-1227.
[9]吴庆华,包皙婷,孔雷,等.使用常规器械经脐入路腹腔镜胆囊切除术491例报告[J].肝胆胰外科杂志,2016,28(4):265-269.
[10]杨澎,朱宇.保胆取石术治疗胆囊结石203例回顾性研究[J].肝胆胰外科杂志,2018,30(1):58-61.
[11]李留峥,向春明,徐雷升,等.两孔法腹腔镜保胆取石术60例体会[J].肝胆胰外科杂志,2016,28(5):412-415.
[12]刘文松,孙冬林,朱峰,等.腹腔镜胆总管探查治疗胆囊切除术后复发或残留胆总管结石的临床疗效[J].中国普通外科杂志, 2016, 25(2):209-213.
[13]郭绍红, Maria Coats, Sami M Shimi.胆囊切除术与消化道癌症的风险:一项系统性综述[J].中国微创外科杂志, 2017,17(1):27-32.
[14]于文涛,吴硕东,于晓鹏.腹腔镜联合胆囊镜胆囊息肉摘除术的临床应用[J].中华普通外科杂志, 2016, 31(11):911-913.
[15]王辉华,陈勇,李江华.微创内镜保胆术与腹腔镜胆囊切除术治疗胆囊息肉疗效比较[J].海南医学, 2016, 27(15):2206-2207.
[16]张蔚,薛皓皓,李雯,等.腹腔镜内镜微创保胆术治疗胆囊息肉的meta分析[J].中国医科大学学报, 2016, 45(11):1013-1016.
[17]王亚峰.腹腔镜微创保胆术治疗胆囊息肉的临床效果观察[J].中国医药指南, 2017, 15(24):164-165.
[18]刘永茂,李之令,刘江伟,等.微创保胆术后胆囊结石、息肉复发相关因素分析[J].山东医药, 2017, 57(23):94-96.
[19]刘玉翔,叶昱坪.腹腔镜联合胆道镜保胆取石术后预防胆囊结石复发的方法[J].中国实用医刊, 2017, 44(2):62-64.