CAJ | 학술논문

目的：探讨腹腔镜联合胆道镜取石治疗胆管结石的疗效及安全性。方法回顾性分析2009年1月至2014年6月在广东省湛江中心人民医院收治的172例胆管结石患者临床资料。其中男65例，女107例；平均年龄（44±7）岁。所有患者均签署知情同意书，符合医学伦理学规定。根据手术方式的不同将患者分为腹腔镜联合胆道镜取石组（微创组，85例），传统开腹取石组（传统组，87例）。微创组患者行腹腔镜胆总管切开+胆道镜取石术，传统组行开腹胆总管切开取石+T管引流术。观察两组患者围手术期情况、术后并发症及手术疗效。两组资料比较采用t检验、χ2检验或Fisher确切概率法。结果微创组术中出血量为（76±20）ml，明显少于传统组的（206±87）ml（t=-13.42，P<0.05）。微创组术后排气时间、排便时间、恢复半流质饮食时间分别为（2.4±1.0）、（4.2±2.1）、（4.5±1.0）d，明显短于传统组的（3.5±1.5）、（5.3±1.4）、（4.9±1.5） d（t=-5.645，-4.051，-2.053；P<0.05）。微创组术后住院时间为（7.3±2.5）d，明显短于传统组的（9.5±2.7）d（t=-5.542，P<0.05）。微创组切口脂肪液化或愈合不良发生率为1%（1/85），明显低于传统组的8%（7/87）（χ2=4.575，P<0.05）。微创组和传统组治愈率均为91%，差异无统计学意义（χ2=0.002，P>0.05）。结论腹腔镜联合胆道镜取石治疗胆管结石可以取得与开腹手术相似的疗效，并且具有安全性高、术后恢复快、住院时间短的优点。
목적：탐토복강경연합담도경취석치료담관결석적료효급안전성。방법회고성분석2009년1월지2014년6월재광동성담강중심인민의원수치적172례담관결석환자림상자료。기중남65례，녀107례；평균년령（44±7）세。소유환자균첨서지정동의서，부합의학윤리학규정。근거수술방식적불동장환자분위복강경연합담도경취석조（미창조，85례），전통개복취석조（전통조，87례）。미창조환자행복강경담총관절개+담도경취석술，전통조행개복담총관절개취석+T관인류술。관찰량조환자위수술기정황、술후병발증급수술료효。량조자료비교채용t검험、χ2검험혹Fisher학절개솔법。결과미창조술중출혈량위（76±20）ml，명현소우전통조적（206±87）ml（t=-13.42，P<0.05）。미창조술후배기시간、배편시간、회복반류질음식시간분별위（2.4±1.0）、（4.2±2.1）、（4.5±1.0）d，명현단우전통조적（3.5±1.5）、（5.3±1.4）、（4.9±1.5） d（t=-5.645，-4.051，-2.053；P<0.05）。미창조술후주원시간위（7.3±2.5）d，명현단우전통조적（9.5±2.7）d（t=-5.542，P<0.05）。미창조절구지방액화혹유합불량발생솔위1%（1/85），명현저우전통조적8%（7/87）（χ2=4.575，P<0.05）。미창조화전통조치유솔균위91%，차이무통계학의의（χ2=0.002，P>0.05）。결론복강경연합담도경취석치료담관결석가이취득여개복수술상사적료효，병차구유안전성고、술후회복쾌、주원시간단적우점。
ObjectiveTo investigate the efficacy and safety of laparoscope combined with choledochoscopic lithotomy for cholangiolithiasis.MethodsClinical data of 172 patients with cholangiolithiasis treated in the Central People's Hospital of Zhanjiang, Guangdong Province between January 2009 and June 2014 were retrospectively studied. Among the 172 patients, 65 were males and 107 were females with the average age of (44±7) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. According to the different surgical procedures, the patients were divided into the laparoscope combined with choledochoscopic lithotomy group (minimally invasive group,n=85) and the traditional open lithotomy group (traditional group,n=87). The patients in the minimally invasive group underwent laparoscopic common bile duct exploration + choledochoscopic lithotomy, while the patients in the traditional group underwent open common bileduct exploration + T-tube drainage. The perioperative conditions, postoperative complications and surgical curative effect of the two groups were compared. The data of the two groups were compared usingt test , Chi-square test or Fisher's exact probability test.Results The intraoperative blood loss of the minimally invasive group was (76±20) ml, which was significantly lower than (206±87) ml of the traditional group (t=-13.42,P<0.05). The postoperative evacuation time, defecation time and time of recovery to semi-liquid diet were respectively (2.4±1.0), (4.2±2.1) and (4.5±1.0) d, which were signiifcantly shorter than (3.5±1.5), (5.3±1.4) and (4.9±1.5) d of the traditional group (t=-5.645,-4.051,-2.053;P<0.05). The postoperative length of hospital stay of the minimally invasive group was (7.3±2.5) d, which was signiifcantly shorter than (9.5±2.7) d of the traditional group (t=-5.542,P<0.05). The incidence of incision fat liquefaction or poor healing of the minimally invasive group was 1% (1/85), which was significantly lower than 8% (7/87) of the traditional group (χ2=4.575,P<0.05). The cure rate of the minimally invasive group and the traditional group was both 91% and no signiifcant difference was observed (χ2=0.002,P>0.05). ConclusionsLaparoscope combined with choledochoscopic lithotomy for cholangiolithiasis has the same efifcacy with open lithotomy and has the advantages of high safety, quick postoperative recovery and short length of hospital stay.