腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石治疗胆总管下段嵌顿结石的回顾性分析
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摘要
目的研究腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石治疗胆总管下段嵌顿结石的临床疗效。方法收集我院2013年5月至2016年5月60例胆总管下段嵌顿结石患者病历资料,进行回顾性分析。根据手术方式不同将患者分为腹腔镜组与传统开腹组,每组30例。腹腔镜组采用腹腔镜下胆总管低位切开与腹腔镜下钬激光碎石,传统开腹组采用开腹胆总管切开取石。比较两组应激指标、术中指标、术后恢复情况、并发症与复发率。结果腹腔镜组取石时间、术中出血量、肛门排气时间、住院时间分别为(7.87±2.52)min、(36.41±9.21)ml、(1.63±0.68)d、(10.86±2.53)d显著低于传统开腹组的(13.25±3.67)min、(82.13±24.75)ml、(2.60±0.91)d、(15.77±4.41)d(P<0.05),结石残留率、切口感染率、胆瘘发生率、结石复发率分别为3.3%、0·0%、3.3%、6.7%显著低于传统开腹组的20.0%、13.3%。20.0%、26.7%(P<0.05)。结论腹腔镜下胆总管低位切开与腹腔镜钬激光治疗胆总管下段嵌顿结石,可以有效清除结石,对机体损伤较轻,术后并发症较少,有利于患者术后康复。
Objective To study the clinical eff-icacy of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stones. Methods The medical records of 60 patients with distal common bile duct incarceration stones treated in our hospital from May 2013 to May 2016 were collected and analyzed retrospectively. According to different surgical methods, the patients were divided into the laparoscopic group and the traditional open group, 30 cases in each group. The laparoscopic group were treated by laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy while the open group were treated by open common bile duct exploration. The stress indexes, intraoperative indexes,postoperative recovery, complications and recurrence rate were compared between the two groups. Results The time for stone removal,intraoperative blood loss,anal exhaust time and hospital stay of the laparoscopic group [(7.87 ± 2. 52) min,(36. 41 ±9.21) ml,(1.63 ±0.68) d,(10.86 ±2.53) d were significantly shorter than or less than those of the open group [(13.25 ±3.67) min,(82.13 ± 24. 75) ml,( 2. 60 ± 0. 91) d,( 15. 77 ± 4. 41) d(P < 0. 05). The stone residual rate,incision infection rate,the incidence of biliary fistula and stone recurrence rate in the laparoscopic group(3. 3%, 0. 0%, 3. 3%, 6.7%) were significantly lower than those in the open group(20. 0%, 13. 3%, 20. 0%, 26. 7%)(P < 0. 05). Conclusion The application of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stonescan completely remove the stones, the damage to the body is reltively milder, and the postoperative complications are few, which is conducive to the recovery of patients after operation.
Objective To study the clinical eff-icacy of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stones. Methods The medical records of 60 patients with distal common bile duct incarceration stones treated in our hospital from May 2013 to May 2016 were collected and analyzed retrospectively. According to different surgical methods, the patients were divided into the laparoscopic group and the traditional open group, 30 cases in each group. The laparoscopic group were treated by laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy while the open group were treated by open common bile duct exploration. The stress indexes, intraoperative indexes,postoperative recovery, complications and recurrence rate were compared between the two groups. Results The time for stone removal,intraoperative blood loss,anal exhaust time and hospital stay of the laparoscopic group [(7.87 ± 2. 52) min,(36. 41 ±9.21) ml,(1.63 ±0.68) d,(10.86 ±2.53) d were significantly shorter than or less than those of the open group [(13.25 ±3.67) min,(82.13 ± 24. 75) ml,( 2. 60 ± 0. 91) d,( 15. 77 ± 4. 41) d(P < 0. 05). The stone residual rate,incision infection rate,the incidence of biliary fistula and stone recurrence rate in the laparoscopic group(3. 3%, 0. 0%, 3. 3%, 6.7%) were significantly lower than those in the open group(20. 0%, 13. 3%, 20. 0%, 26. 7%)(P < 0. 05). Conclusion The application of laparoscopic low incision of common bile duct and laparoscopic holmium laser lithotripsy in the treatment of distal common bile duct incarceration stonescan completely remove the stones, the damage to the body is reltively milder, and the postoperative complications are few, which is conducive to the recovery of patients after operation.
引文
1吴松,杨成林.LCBDE与OCBDE治疗胆总管结石的临床疗效对比.湖南师范大学学报(医学版),2016,13(5):123-125,126.
2袁赛,肖萤.不同影像学方法在胆总管下段结石中的诊断价值.医学临床研究,2016,33(4):769-771.
3吴孟超,吴在德,吴肇汉.外科学(第8版).北京:人民卫生出版社,2013:457-459.
4贾捷鹏,邵泉,张继军等.内镜下乳头肌小切开术联合球囊扩张治疗老年人胆总管结石疗效分析.中国基层医药,2016,23(20):3163-3166,3167.
5徐本文,牛四龙,崔红燕,等.两镜联合辅助钬激光治疗胆总管嵌顿结石的疗效.江苏医药,2015,41(21):2584-2585.
6李贵全,吴本华,黄家斌,等.一期缝合与术中留置T管在腹腔镜胆总管探查取石术中的应用效果比较.蚌埠医学院学报,2015,40(8):1032-1035.
7刘南,李福,张敏,等.乳头开窗联合大球囊扩张术治疗胆总管末端嵌顿巨大结石的临床应用.中国内镜杂志,2016,22(1):103-105.
8张华国,郭云虎.胆囊结石合并胆总管结石采用腹腔镜联合胆道镜的临床疗效观察.湖南师范大学学报(医学版),2016,13(1):51-53.
9谢海龙,关超,谷明利,等.电子输尿管软镜联合钬激光治疗肾、输尿管上段结石的效果观察.蚌埠医学院学报,2016,41(5):619-622.
10苟成毅,曲小勇,高永峰,等.经输尿管硬镜钬激光碎石治疗输尿管结石临床观察.中国基层医药,2015,22(1):128-129.
11侯海春.腹腔镜手术对腹部手术患者围术期应激及凝血功能的影响.血栓与止血学,2017,23(2):265-267.
12朱堃,王建平,苏进根.ESBD和EST治疗胆总管结石患者术中情况和术后炎症反应、免疫应答的比较.海南医学院学报,2016,22(16):1829-1832.
13杨玉泰.腹腔镜下纤维胆管镜取石术在胆总管结石取石中的疗效.医学综述,2016,22(18):3730-3732.
14刘和荣,沈文华,周厚吾.ERCP+EST术后早期行LC术治疗胆囊结石合并胆总管结石临床疗效观察.医学临床研究,2017,34(3):556-558.
2袁赛,肖萤.不同影像学方法在胆总管下段结石中的诊断价值.医学临床研究,2016,33(4):769-771.
3吴孟超,吴在德,吴肇汉.外科学(第8版).北京:人民卫生出版社,2013:457-459.
4贾捷鹏,邵泉,张继军等.内镜下乳头肌小切开术联合球囊扩张治疗老年人胆总管结石疗效分析.中国基层医药,2016,23(20):3163-3166,3167.
5徐本文,牛四龙,崔红燕,等.两镜联合辅助钬激光治疗胆总管嵌顿结石的疗效.江苏医药,2015,41(21):2584-2585.
6李贵全,吴本华,黄家斌,等.一期缝合与术中留置T管在腹腔镜胆总管探查取石术中的应用效果比较.蚌埠医学院学报,2015,40(8):1032-1035.
7刘南,李福,张敏,等.乳头开窗联合大球囊扩张术治疗胆总管末端嵌顿巨大结石的临床应用.中国内镜杂志,2016,22(1):103-105.
8张华国,郭云虎.胆囊结石合并胆总管结石采用腹腔镜联合胆道镜的临床疗效观察.湖南师范大学学报(医学版),2016,13(1):51-53.
9谢海龙,关超,谷明利,等.电子输尿管软镜联合钬激光治疗肾、输尿管上段结石的效果观察.蚌埠医学院学报,2016,41(5):619-622.
10苟成毅,曲小勇,高永峰,等.经输尿管硬镜钬激光碎石治疗输尿管结石临床观察.中国基层医药,2015,22(1):128-129.
11侯海春.腹腔镜手术对腹部手术患者围术期应激及凝血功能的影响.血栓与止血学,2017,23(2):265-267.
12朱堃,王建平,苏进根.ESBD和EST治疗胆总管结石患者术中情况和术后炎症反应、免疫应答的比较.海南医学院学报,2016,22(16):1829-1832.
13杨玉泰.腹腔镜下纤维胆管镜取石术在胆总管结石取石中的疗效.医学综述,2016,22(18):3730-3732.
14刘和荣,沈文华,周厚吾.ERCP+EST术后早期行LC术治疗胆囊结石合并胆总管结石临床疗效观察.医学临床研究,2017,34(3):556-558.