CAJ | 학술논문

目的研究腹腔镜与开腹手术行胆总管切开取石术的临床效果。方法对同一时期124例胆总管结石病人手术资料进行回顾性分析,分为腹腔镜胆总管切开取石探查+T 管引流术组(laparoscopic choledocholithotomy T-tube drainage,LCHTD,n=78)和开腹胆总管切开取石+T 管引流术组(open choledocholithotomy T-tube drainage,OCHTD,n=46)。分析对比两组病人的术前、术中和术后临床资料。结果两组术前临床资料比较差异无统计学意义(P >0.05),具有可比性。LCHTD 和 OCHTD 两组在术中失血量[(35.2±17.1)ml 和(190.3±37.5)ml]、术后胃肠蠕动恢复时间[(34.8±6.3)h 和(61.5±17.6)h]、术后平均住院时间[(5.7±1.7)d 和(10.0±2.3)d]、术后镇痛率(8.97%和58.70%)和切口感染发生率(2.56%和28.26%)方面差异均具有统计学意义(P <0.05或 P <0.01)。两组平均手术时间差异无统计学意义(P >0.05)；手术后 T 管造影均未发现残余结石和胆漏的发生。结论腹腔镜下行胆总管切开取石术+T 管引流术具有手术创伤小、恢复快、安全,临床效果好,能够取代部分 OCHTD。
목적연구복강경여개복수술행담총관절개취석술적림상효과。방법대동일시기124례담총관결석병인수술자료진행회고성분석,분위복강경담총관절개취석탐사+T 관인류술조(laparoscopic choledocholithotomy T-tube drainage,LCHTD,n=78)화개복담총관절개취석+T 관인류술조(open choledocholithotomy T-tube drainage,OCHTD,n=46)。분석대비량조병인적술전、술중화술후림상자료。결과량조술전림상자료비교차이무통계학의의(P >0.05),구유가비성。LCHTD 화 OCHTD 량조재술중실혈량[(35.2±17.1)ml 화(190.3±37.5)ml]、술후위장연동회복시간[(34.8±6.3)h 화(61.5±17.6)h]、술후평균주원시간[(5.7±1.7)d 화(10.0±2.3)d]、술후진통솔(8.97%화58.70%)화절구감염발생솔(2.56%화28.26%)방면차이균구유통계학의의(P <0.05혹 P <0.01)。량조평균수술시간차이무통계학의의(P >0.05)；수술후 T 관조영균미발현잔여결석화담루적발생。결론복강경하행담총관절개취석술+T 관인류술구유수술창상소、회복쾌、안전,림상효과호,능구취대부분 OCHTD。
Objective To explore open surgery and laparoscopic choledocholithotomy clinical re-sults.Methods Retrospective analyses were conducted for 124 surgical cases of choledocholithiasis during the same period.They underwent laparoscopic choledocholithotomy T-tube drainage (LCHTD, n=78)and open choledocholithotomy T-tube drainage (OCHTD,n=46).Comparisons of pre,intra and post-operative clinical data were made for both groups.Results No statistically significant differ-ences existed in preoperative data (P >0.05).The intra-operative blood loss,post-operative recovery time of gastrointestinal peristalsis and the average length of hospitalization stay were (35.2±1 7.1)vs (190.3±37.5)ml,(34.8±6.3)vs (61 .5 ± 1 7.6)hours and (5.7 ± 1 .7)vs(10.0 ±2.3)days re-spectively in two groups.The percentages of postoperative pain and postoperative incision infection were 8.97% vs 58.70% and 2.56% vs 28.26% respectively.And there were significant statistical differences(P <0.05 or P <0.01).No statistically significant inter-group difference existed in average operative duration (P >0.05).On T tube imaging,there was no occurrence of residual stone or bile leakage in neither group.Conclusions Laparoscopic surgery choledocholithotomy plus T tube drainage has the advantages of mini-invasiveness,quicker recovery and greater safety so that it may replace most open procedures.