魏志力，耿智敏

腹腔镜手术与传统手术治疗胆管结石临床疗效对比研究

魏志力，耿智敏

目的比较腹腔镜手术与传统手术治疗胆管结石患者的临床效果。方法回顾性分析2012年1月～2015年6月我院收治的胆管结石患者的临床病历资料，其中观察组行腹腔镜微创手术，对照组行传统开腹手术，比较两组患者术后的临床治疗效果及安全性。结果观察组手术时间、胃肠恢复时间、术后住院时间分别为（65.32± 11.67）min、（11.73±6.59）h和（5.7±2.3）d，短于对照组【分别为（92.80±13.55）min、（32.86±8.29）h和（9.6± 1.9）d，P<0.05】；观察组术中出血量和术后引流量分别为（34.62±10.85）m l和（17.25±5.34）m l，少于对照组的（62.31±13.76）m l和（36.87±6.04）m l（均P<0.05）；观察组住院总费用高于对照组【（6320.5±775.0）元对（4971.4± 896.3）元，P<0.05】；两组患者术后均发生不同程度的并发症如出血、切口感染、胆总管结石、肝源性胰腺炎、胆漏和胆管损伤，其中观察组术后出血、切口感染和肝源性胰腺炎发生率分别为3.26%、2.17%和2.17%，低于对照组的13.43%、10.45%和13.43%，差异有统计学意义（P<0.05），两组患者胆总管结石、胆漏和胆管损伤发生率差异无统计学意义（P>0.05）。结论腹腔镜手术治疗胆管结石具有疗效显著，安全性高的特点，临床有重要的推广价值。

胆管结石；腹腔镜手术；传统开腹手术；临床疗效

【Abstract】Objective To compare the clinical efficacy and safety of laparoscopic surgery and conventional surgery in the treatment of patients with biliary calculi.Methods The clinical data of patients with biliary calculi in our hospital from January 2012 to June 2015 were retrospectively analyzed.The patients in observation group underwent laparoscopic minimally invasive procedure，while in the control group was treated by conventional open surgery.The clinical efficacy and safety of these two methods were compared.Resu lts The operation durations，times for the recovery of gastrointestinal functions，and postoperative hospital stays in observation group were shorter than those in control group[（65.32±11.67）min vs.（92.80±13.55）min，（11.73±6.59）h vs.（32.86± 8.29）h，and（5.7±2.3）d vs.（9.6±1.9）d，respectively，P<0.05 for all]；the amounts of bleeding during surgery and the volumes of postoperative drainage were lower in observation group as well[（34.62±10.85）m l vs.（62.31± 13.76）ml，（17.25±5.34）m l vs.（36.87±6.04）ml，respectively，P<0.05 for both]；However，the hospitalization expense in observation group was higher than that in control group[（6320.5±775.0）yuan vs.（4971.4±896.3）yuan，P<0.05]；Postoperative complications，such as postoperative bleeding，infection at incision，choledocholithiasis，hepatogenic pancreatitis，biliary leakage and bile duct injury，occurred in both groups，but the incidences of postoperative bleeding，infection，and hepatogenic pancreatitis in observation group（3.26%，2.17%，and 2.17%，respectively），were significantly lower than those in control group（13.43%，10.45%and 13.43%，respectively，P<0.05 for all）；The incidences of choledocholithiasis，biliary leakage and bile duct injury in both groups were of no difference.Conclusion Laparoscopic surgery has been proved clinically effective and safe in the treatment of patients with biliary calculi，and is worth practicing.

【Key words】Biliary calculi；Laparoscopic surgey；Conventional open surgery；Clinical efficacy

胆管结石是肝胆外科常见的胆道系统疾病，包括胆囊结石和胆管结石等，其中胆管结石主要包括肝内胆管结石和肝外胆管结石。胆管结石的特点为发病率高、排石不畅以及溶石困难等，报道显示其发病率呈逐渐升高的趋势，严重影响患者的健康和生命质量[1，2]。研究表明，当结石堵塞胆管时会引起胆汁淤积，从而导致细菌感染而致急性胆管炎。因此，及时有效治疗胆管结石是提高临床治疗效果，改善预后的关键[3]。目前，手术治疗是临床治疗胆管结石最主要的手段，但是研究发现传统开腹手术治疗胆管结石对患者的创伤较大，术后并发症较多[4，5]。随着腹腔镜技术的快速发展和不断完善，在腹腔镜辅助下手术治疗肝内外胆管结石逐渐受到临床医生的广泛关注，并逐渐在临床得到开展。……