“水冲取石法”在腹腔镜保胆手术中的应用及临床分析
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摘要
目的:探讨腹腔镜保胆手术中应用"水冲取石法"治疗多发胆囊结石的应用及临床疗效。方法:选取2016年1月至2018年1月治疗的胆囊多发小结石患者。首先将符合纳入标准的患者随机分为3组,每组20例,于保胆取石过程中分别采用不同的冲洗压力(60 mmHg、70 mmHg、80 mmHg),以确定水冲取石法最适宜的冲洗压力值。将符合纳入标准的60患者随机分为水冲取石组与网篮取石组,每组30例,比较两种取石方式单位时间(min)取石数量、排气时间、住院时间、拆线时间。结果:70 mmHg组与80 mmHg组单位时间(min)取石数量大于60 mmHg组,差异有统计学意义(P<0.05);但70 mmHg组与80 mmHg组之间差异无统计学意义(P>0.05)。水冲取石法单位时间(min)的取石数量优于网篮取石组(P<0.05),两组首次肛门通气时间、术后住院时间及拆线时间差异无统计学意义(P>0.05)。结论:腹腔镜保胆手术中应用"水冲取石法"治疗多发胆囊小结石具有术中取石时间短的优势,其最适宜的冲洗压力为70 mmHg。
Objective: To explore the application and clinical efficacy of"water flushing stone method"in the treatment of multiple small gallstones in laparoscopic gallbladder-preserving surgery.Methods: The study selected patients with multiple small gallstones from Jan.2016 to Jan.2018.The patients who met the inclusion criteria were randomly divided into 3 groups( n = 20),and different irrigation pressure values( 60 mmHg,70 mmHg,80 mmHg) were used to wash and remove stones during the process of removing gallstones,in order to determine the optimum flushing pressure value of "water flushing stone method".60 patients who met the inclusion criteria were randomly divided into two groups: the water flushing stone group( n = 30) and the basket stone removal group( n = 30).The removed stone number in unit time( min),exhaust time,postoperative hospitalization time and suture removal time were compared between the two groups.Results: The removed stone number in unit time( min) was more in the 70 mmHg group and the 80 mmHg group than that in the 60 mmHg group( P<0.05),and there was no significant difference between the 70 mmHg group and the 80 mmHg group( P>0.05).The 70 mmHg was determined as the optimum flushing pressure value.The water flushing stone group was better than basket stone removal group in the number of stones removed per unit time( P<0.05).There were no significant differences in the first anal ventilation time,postoperative hospitalization time,and suture removal time between the two groups. Conclusions: "Water flushing stone method"has the advantage of short stone removal time in laparoscopic gallbladder-preserving surgery for the treatment of multiple small gallstones.The optimum flushing pressure value is 70 mmHg.
Objective: To explore the application and clinical efficacy of"water flushing stone method"in the treatment of multiple small gallstones in laparoscopic gallbladder-preserving surgery.Methods: The study selected patients with multiple small gallstones from Jan.2016 to Jan.2018.The patients who met the inclusion criteria were randomly divided into 3 groups( n = 20),and different irrigation pressure values( 60 mmHg,70 mmHg,80 mmHg) were used to wash and remove stones during the process of removing gallstones,in order to determine the optimum flushing pressure value of "water flushing stone method".60 patients who met the inclusion criteria were randomly divided into two groups: the water flushing stone group( n = 30) and the basket stone removal group( n = 30).The removed stone number in unit time( min),exhaust time,postoperative hospitalization time and suture removal time were compared between the two groups.Results: The removed stone number in unit time( min) was more in the 70 mmHg group and the 80 mmHg group than that in the 60 mmHg group( P<0.05),and there was no significant difference between the 70 mmHg group and the 80 mmHg group( P>0.05).The 70 mmHg was determined as the optimum flushing pressure value.The water flushing stone group was better than basket stone removal group in the number of stones removed per unit time( P<0.05).There were no significant differences in the first anal ventilation time,postoperative hospitalization time,and suture removal time between the two groups. Conclusions: "Water flushing stone method"has the advantage of short stone removal time in laparoscopic gallbladder-preserving surgery for the treatment of multiple small gallstones.The optimum flushing pressure value is 70 mmHg.
引文
[1]许旭,张立广,李全福.内镜保胆取石术后结石复发分析:720例保胆患者随访资料[J].腹腔镜外科杂志,2017,22(5):349-351.
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[6]皮儒先,龙玉屏,樊惠菱,等.腹腔镜胆囊切除术治疗急性胆囊炎并发胆结石的安全性及预后评估[J].重庆医学,2018,47(2):198-199,202.
[7]王汉长.双镜联合保胆取石与腹腔镜胆囊切除术治疗胆结石的临床疗效比较[J].中国临床新医学,2018,11(1):61-64.
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[9]张诚,林美举,杨玉龙,等.胆囊结石患者全麻术中胆囊压力升高的影响因素分析[J].肝胆胰外科杂志,2018,30(1):18-21.
[10]甄永强,徐文样,张丽华,等.双镜联合微创保胆取石术与腹腔镜胆囊切除术的临床对比研究[J/CD].中华普外科手术学杂志(电子版),2018,12(1):85-87.
[11]吴春生.内镜微创保胆取石术对肝功能的影响[J].腹腔镜外科杂志,2017,22(5):345-348.
[12]阿力木江·阿布都热衣木,艾武,张浩.南疆地区高脂血症与胆囊结石成因的相关性研究[J].中国现代普通外科进展,2017,20(1):63-65.
[13]陈愉快.微创保胆取石术与腹腔镜胆囊切除术治疗胆结石的临床疗效比较[J].中国医学创新,2018,15(2):113-117.
[14]庞智学.腹腔镜与开腹保胆取石术治疗胆囊结石的对比研究[J].中国实用医药,2018,13(2):37-38.
[2]徐浩,孙举来,芮翾,等.胆囊结石合并胆总管结石的微创治疗体会[J].腹腔镜外科杂志,2017,22(5):352-355.
[3]郭怀斌,潘毓,暴雷,等.瘦素对血脂及胆汁成分的调节在胆囊胆固醇结石形成中的作用[J].中国普通外科杂志,2018,27(2):204-209.
[4]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.
[5]米利晓,孙建男,赵恒宇,等.影像学方法鉴别胆囊结石成分的研究进展[J].中国临床医学影像杂志,2018,29(3):215-217.
[6]皮儒先,龙玉屏,樊惠菱,等.腹腔镜胆囊切除术治疗急性胆囊炎并发胆结石的安全性及预后评估[J].重庆医学,2018,47(2):198-199,202.
[7]王汉长.双镜联合保胆取石与腹腔镜胆囊切除术治疗胆结石的临床疗效比较[J].中国临床新医学,2018,11(1):61-64.
[8]李昭琪,王晓艳,肖定华.胆囊良性疾病保留胆囊与切除胆囊治疗策略的选择[J].内科急危重症杂志,2018,24(1):4-7.
[9]张诚,林美举,杨玉龙,等.胆囊结石患者全麻术中胆囊压力升高的影响因素分析[J].肝胆胰外科杂志,2018,30(1):18-21.
[10]甄永强,徐文样,张丽华,等.双镜联合微创保胆取石术与腹腔镜胆囊切除术的临床对比研究[J/CD].中华普外科手术学杂志(电子版),2018,12(1):85-87.
[11]吴春生.内镜微创保胆取石术对肝功能的影响[J].腹腔镜外科杂志,2017,22(5):345-348.
[12]阿力木江·阿布都热衣木,艾武,张浩.南疆地区高脂血症与胆囊结石成因的相关性研究[J].中国现代普通外科进展,2017,20(1):63-65.
[13]陈愉快.微创保胆取石术与腹腔镜胆囊切除术治疗胆结石的临床疗效比较[J].中国医学创新,2018,15(2):113-117.
[14]庞智学.腹腔镜与开腹保胆取石术治疗胆囊结石的对比研究[J].中国实用医药,2018,13(2):37-38.