摘要
目的评估腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查术(Laparoscopic common bile duct exploration,LCBDE)、LC+经内镜逆行性胰胆管造影术(Endoscopic retrograde cholangio pancreatography,ERCP)治疗老年胆囊结石合并胆总管结石(Cholecystolithiasis complicated with choledocholithiasis,CCWC)的疗效及安全性。方法选择2014年1月~2016年8月本院收治的CCWC患者145例作为研究对象,根据随机数字表法将其分为LC+LCBDE组51例、LC+ERCP组49例和对照组45例,对照组患者给予传统开腹胆总管探查手术治疗,LC+LCBDE组患者给予LC+LCBDE治疗、LC+ERCP组患者给予LC+ERCP治疗,记录手术过程中各项指标以及住院情况并进行比较。结果 LC+LCBDE组术中出血量、手术时间、术后肛门排气时间、住院时间以及住院费用显著少于LC+ERCP组、对照组,生存质量评分显著高于LC+ERCP组、对照组,比较具有统计学差异(t值依次为3.364、3.732、3.401、2.704、2.945、2.524,均P<0.05);LC+LCBDE组手术并发症发生率、结石复发率、胆管积气发生率、胆管炎发生率分别显著低于LC+ERCP组、对照组,比较具有统计学差异(χ2值依次为4.113、3.479、3.206、2.767,均P<0.05)。结论 LC+LCBDE治疗CCWC疗效可靠,与LC+ERCP以及传统开腹胆总管探查术相比较,在提高患者生存质量的同时住院时间短、费用少,手术并发症发生率、结石复发率、胆管积气发生率、胆管炎发生率低,值得在临床进行推广应用。
Objective To discuss the efficacy and safety of three different surgicaL methods in the treatment of patients with CCWC. Methods 145 patients with CCWC in our hosipital form Jan 2014 to Aug 2016 were selected as the research object,randomly divided into LC ＋ LCBDE group（51 cases） ,LC ＋ ERCP group（49 cases） and control group group（45 cases）, patients in the control group were treated with conventional common bile duct exploration, patients in the LC ＋ LCBDE group were treated with LC ＋ LCBDE, patients in the LC ＋ ERCP group were treated with LC ＋ ERCP, recorded and compared the indicators of the operation process and the hospitalization. Results The amount of bleeding, operation time, postoperative anal exhaust time, hospitalization time and hospitaliza- tion expenses of LC ＋ LCBDE group were significantly lower than LC ＋ ERCP group and control group, the score of quality of life was significantly higher than LC ＋ ERCP group and control group, the difference were statistically significant（ the values of t were 3. 364, 3. 732,3.401,2. 704, 2. 945,2. 524 respectively,P 〈 0.05） ; The incidence of postoperative complications, thone recurrence rate, in- cidence of bile duct gas accumulation and cholangitis occurred in LC ＋ LCBDE group were significantly lower than the LC ＋ ERCP group and the control group,the difference were statistically significant （the values of X^2 were 4. 113,3.479,3. 206,2. 767 respectively, P 〈 0. 05 ）. Conclusion Compared with conventional common bile duct exploration and LC ＋ ERCP, LC ＋ LCBDE for the treatment of CCWC is reliable curative effect, while improving the quality of life of patients, the hospital stay is short and the cost is low, the inci- dence of postoperative complications, recurrence rate pneumobilia incidence and incidence of cholangitis are low, it is worth in clinical application.
出处
《肝胆外科杂志》
2017年第1期30-33,共4页
Journal of Hepatobiliary Surgery
关键词
腹腔镜胆囊切除术
经内镜逆行性胰胆管造影术
腹腔镜胆总管探查术
胆囊结石合并胆总管结石
Laparoscopic cholecystectomy
Endoscopic retrograde cholangio pancreatography
Laparoscopic common bile ductexploration
Cholecystolithiasis complicated with choledocholithiasis
