中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
Chinese Journal of General Practitioners
2015年
10期
784-786
,共3页
胆总管结石%腹腔镜检查
膽總管結石%腹腔鏡檢查
담총관결석%복강경검사
Choledocholithiasis%Laparoscopy
对2012年6月至2014年10月48例经超声、磁共振胰胆管造影确诊的胆总管结石患者按数字法随机分为2组,每组各24例.常规组患者行常规腹腔镜胆总管探查手术,手术者位于患者左侧完成手术;改良组操作者在术中适时地由患者左侧转移至患者右侧,主操作孔由剑突下戳孔转换为右腋前线戳孔,利用右侧2个操作孔进行胆总管缝合.结果显示,48例患者均在腹腔镜下完成了胆总管切开探查取石术,两组患者平均胆总管缝合时间[(13.6±2.5) min比(7.6±2.7) min,t=11.365,P=0.000]、术中出血量[(77.52±12.49) ml比(74.91±13.66) ml,t=2.627,P=0.008]、术后3d内最高体温平均值[(38.6±0.5)℃比(37.4±0.5)℃,t=9.954,P=0.000)]、术后平均住院时间(9.2±3.4)d比(7.1±2.1)d,=8.730,P =0.000]比较,差异均有统计学意义.提示,与常规组相比,改良组患者所用胆总管缝合时间明显缩短,术后最高体温平均值明显减低,并发症明显减少;腹腔镜主操作孔转换在腹腔镜胆总管探查术胆总管缝合中具有灵活、方便、适用优点.
對2012年6月至2014年10月48例經超聲、磁共振胰膽管造影確診的膽總管結石患者按數字法隨機分為2組,每組各24例.常規組患者行常規腹腔鏡膽總管探查手術,手術者位于患者左側完成手術;改良組操作者在術中適時地由患者左側轉移至患者右側,主操作孔由劍突下戳孔轉換為右腋前線戳孔,利用右側2箇操作孔進行膽總管縫閤.結果顯示,48例患者均在腹腔鏡下完成瞭膽總管切開探查取石術,兩組患者平均膽總管縫閤時間[(13.6±2.5) min比(7.6±2.7) min,t=11.365,P=0.000]、術中齣血量[(77.52±12.49) ml比(74.91±13.66) ml,t=2.627,P=0.008]、術後3d內最高體溫平均值[(38.6±0.5)℃比(37.4±0.5)℃,t=9.954,P=0.000)]、術後平均住院時間(9.2±3.4)d比(7.1±2.1)d,=8.730,P =0.000]比較,差異均有統計學意義.提示,與常規組相比,改良組患者所用膽總管縫閤時間明顯縮短,術後最高體溫平均值明顯減低,併髮癥明顯減少;腹腔鏡主操作孔轉換在腹腔鏡膽總管探查術膽總管縫閤中具有靈活、方便、適用優點.
대2012년6월지2014년10월48례경초성、자공진이담관조영학진적담총관결석환자안수자법수궤분위2조,매조각24례.상규조환자행상규복강경담총관탐사수술,수술자위우환자좌측완성수술;개량조조작자재술중괄시지유환자좌측전이지환자우측,주조작공유검돌하착공전환위우액전선착공,이용우측2개조작공진행담총관봉합.결과현시,48례환자균재복강경하완성료담총관절개탐사취석술,량조환자평균담총관봉합시간[(13.6±2.5) min비(7.6±2.7) min,t=11.365,P=0.000]、술중출혈량[(77.52±12.49) ml비(74.91±13.66) ml,t=2.627,P=0.008]、술후3d내최고체온평균치[(38.6±0.5)℃비(37.4±0.5)℃,t=9.954,P=0.000)]、술후평균주원시간(9.2±3.4)d비(7.1±2.1)d,=8.730,P =0.000]비교,차이균유통계학의의.제시,여상규조상비,개량조환자소용담총관봉합시간명현축단,술후최고체온평균치명현감저,병발증명현감소;복강경주조작공전환재복강경담총관탐사술담총관봉합중구유령활、방편、괄용우점.
During June 2012 to October 2014, a total of 48 patients with stones in common bile duct diagnosed by ultrasound and magnetic resonance cholangiopancreatography (MRCP) were randomly divided into two groups (n =24 each).The general group underwent conventional common bile duct exploration by laparoscopy (LCHTD) at left side.For improvement group, the operator timely transfered from left side to right side during laparoscopy.And two auxiliary holes of right side were used for suturing common bile duct.All patients successfully completed common bile duct exploration by laparoscopy.The suturing times of common bile duct were (13.6 ± 2.5) & (7.6 ± 2.7) min (t =11.365, P =0.000), intraoperative bleeding volume (77.52 ± 12.49) & (74.91 ± 13.66) ml (t =2.627,P =0.008), average peak temperature at day 3 post-operation (38.6 ± 0.5) & (37.4 ± 0.5) ℃ (t =9.954, P =0.000) and average postoperative hospitalization length (9.2 ± 3.4) & (7.1 ± 2.1) days (t =8.730, P =0.000).Compared with general group, the suturing time of common bile duct was significantly shorter in improvement group, the average highest temperature at day 3 post-operation were lower and complications (bile leakage, bile duct stricture & biliary tract bleeding) decreased significantly.The main hole conversion during common bile duct exploration by laparoscopy offers the advantages of flexibility, convenience and applicability.
