摘要
目的 比较腹腔镜胆囊切除术(LC)联合内镜下十二指肠乳头括约肌小切开加球囊扩张术(ESBD)与LC+胆总管探查术(LCBDE)治疗胆囊结石合并胆总管结石的临床疗效。方法 采用回顾性研究的方法,收集重庆医科大学附属第二医院2015年10月-2017年10月收治的102 例胆囊结石合并胆总管结石患者的临床资料,其中,48 例患者采用LC+ESBD治疗(LC+ESBD组),54 例采用LC+LCBDE治疗(LC+LCBDE组)。比较两组患者的手术时间、术中出血量、术后腹腔引流时间、抗生素使用率、结石残余率等。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验。非正态分布的计量资料,用M(P25,P75)表示,组间比较采用Mann-Whitney U检验。计数或等级数据组间比较采用χ2检验。结果 LC+ESBD组患者手术时间、术中出血量、术后腹腔引流时间、抗生素使用率分别为(108.0±23.4) min、(18.0±7.1) ml、(1.83±1.57) d、47.9%(23/48),LC+LCBDE组患者分别为(169.6±37.8) min、(86.4±37.0) ml、(4.80±2.02) d、87.0%(47/54),两组间比较差异有统计学意义(P<0.05)。LC+ESBD组结石残余率为0,LC+LCBDE组为5.6%(3/54),两组间差异无统计学意义(P>0.05)。结论 LC+ESBD及LC+LCBDE均为治疗胆囊结石合并胆总管结石安全、有效的方法,但LC+ESBD组患者全身麻醉时间短,手术的创伤更小,恢复时间更短,更加适合于合并有心肺等基础疾病、手术耐受力差的患者。
Objective To compare the clinical efficacy of laparoscopic cholecystectomy(LC)+endoscopic sphincterotomy combined with balloon dilation(ESBD) with laparoscopic cholecystectomy(LC)+common bile duct exploration(LCBDE) on cholecystolithiasis combined with choledocholithiasis. Methods The clinical data of 102 patients with gallbladder stones with common bile duct stones from October 2015 to October 2017 were reviewed from the Second Affiliated Hospital of Chongqing Medical University.Forty eight patients received LC+ESBD and 54 patients subjected to LC+LCBDE.The operation time,intraoperative blood loss,abdominal drainage time,antibiotic utilization rate, stone residue rate were compared between the two groups. Measurement data with normal distribution were represented as (Mean±SD), and t test was used to compare between groups.Measurement data with skewed distribution were represented as M(P25,P75), Mann-whitney U test was used to compare between groups. Categorical variables were describedas counts and percentages and were compared using chi-square test. Results The operation time, intraoperative blood loss, postoperative abdominal drainage time, and antibiotic utilization rate in the LC+ESBD group were (108.0±23.4) min, (18.0±7.1) ml, (1.83±1.57) d, and 47.9%(23/48). The LC+LCBDE groups were (169.6±37.8) min, (86.4±37.0) ml, (4.80±2.02) d, and 87.0%(47/54), respectively, there were statistically significant differences between the two groups(P<0.05).The stone residual rate of the LC+ESBD group was 0, and the LC+LCBDE group was 5.6%(3/54), respectively. There was no significant difference between the two groups(P>0.05). Conclusions LC + ESBD and LC + LCBDE both are safe and effective methods to treat cholecystolithiasis combined with choledocholithiasis. However, some data of LC+ESBD group are better than the LC+LCBDE group, such as general anesthesia time, surgical trauma and recovery time. Therefore, compared with LC+LCBDE, LC+ESBD may be the more suitable operation type for patients who have cardiovascular diseases and poor tolerance.
作者
张其伟
丁雄
Zhang Qiwei;Ding Xiong(Department of Hepatobiliary Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China)
出处
《国际外科学杂志》
2019年第2期93-97,共5页
International Journal of Surgery
关键词
胆囊切除术
腹腔镜
外科手术
微创性
胆囊结石病
胆总管结石
胆总管探查术
Cholecystectomy, laparoscopic
Surgical procedures, minimally invasive
Cholecystolithiasis
Choledocholithiasis
Laparoscopic common bile duct exploration
作者简介
通信作者:丁雄,Email:dxiong@yeah.net.
