谢文滔 孙松昌

1.湖南中醫药大学研究生院普外科，湖南长沙 410000;2.湖南省常德市第一中医医院普外科，湖南常德 415000

[摘要] 目的 探讨胆结石患者腹腔镜胆囊切除术治疗的有效性及对患者并发症发生的影响。 方法 选取2019年3月至2020年3月行手术治疗的胆结石患者114例，随机分为两组，每组各57例，对照组行传统开腹手术治疗，研究组行腹腔镜胆囊切除术治疗。比较两组的治疗总有效率、疼痛评分、住院时间、排气时间、术中出血量、手术时间、并发症总发生率。 结果 研究组治疗总有效率为94.7%，高于对照组的73.7%，两组比较，差异有统计学意义（P<0.05）;研究组疼痛评分为（2.0±0.3）分，低于对照组的（5.7±1.1）分，两组比较，差异有统计学意义（P<0.05）;研究组住院时间为（6.9±1.0）d、排气时间为（23.0±2.1）h，均短于对照组的（14.0±2.4）d、（37.5±2.6）h，两组比较，差异有统计学意义（P<0.05）;研究组术中出血量为（27.4±2.5）mL、手术时间为（53.1±1.1）min，均少于对照组的（60.3±1.9）mL、（77.3±2.0）min，两组比较，差异有统计学意义（P<0.05）;研究组并发症总发生率为17.5%，低于对照组的38.6%，两组比较，差异有统计学意义（P<0.05）。 结论 胆结石患者采用腹腔镜胆囊切除术治疗，患者术后恢复快、并发症总发生率低，与传统开腹手术相比，患者疼痛更轻、术中出血量更少、手术时间更短、安全性更高，且操作简单、创伤性小，值得临床推广应用。

[关键词] 术后并发症;有效性;胆结石;腹腔镜胆囊切除术;传统开腹手术

[中图分类号] R657.4          [文献标识码] B          [文章编号] 1673-9701（2021）09-0068-03

Effectiveness of laparoscopic cholecystectomy in patients with gallstones and its impacts on incidence of complications

XIE Wentao1   SUN Songchang2

1.Department of General Surgery， Graduate School of Hunan University of Chinese Medicine， Changsha   415000， China; 2.Department of General Surgery， Changde First Hospital of Traditional Chinese Medicine in Hunan Province， Changde  415000， China

[Abstract] Objective To investigate the effectiveness of laparoscopic cholecystectomy in patients with gallstones and its impacts on incidence of complications. Methods A total of 114 patients with gallstones who underwent surgical treatment from March 2019 to March 2020 were selected， and they were randomly divided into two groups， with 57 cases in each group. The control group was treated with conventional laparotomy， while the study group was treated with laparoscopic cholecystectomy. The total treatment effectiveness， pain score， hospitalization time， exhaust time， intraoperative hemorrhage volume， operation duration and total incidence of complications were compared between the two groups. Results The effective rate of the study group was 94.7%， higher than 73.7% of the control group， with statistically significant difference（P<0.05）. The pain score of the study group was（2.0±0.3） points， lower than （5.7±1.1） points of the control group， with statistically significant difference（P<0.05）. The hospitalization time and exhaust time of the study group were （6.9±1.0） days and （23.0±2.1） hours， both shorter than （14.0±2.4） days and （37.5±2.6） hours of the control group， respectively， with statistically significant differences （P<0.05）. The intraoperative hemorrhage volume and operation duration of the study group were （27.4±2.5） mL and （53.1±1.1） min， both less than （60.3±1.9） mL and （77.3±2.0） min of the control group， respectively， with statistically significant differences （P<0.05）. The total incidence of complications in the study group was 17.5%， lower than 38.6% in the control group， with statistically significant difference （P<0.05）. Conclusion Patients with gallstones who are treated with laparoscopic cholecystectomy can recover quickly， and their total incidence of complications is low. Compared with conventional laparotomy， the patients have lighter pain， less intraoperative hemorrhage volume， shorter operation duration， higher safety， with simpler operation and less trauma， which is worthy of clinical recommendation and application.

[Key words] Postoperative complications; Effectiveness; Gallstones; Laparoscopic cholecystectomy; Conventional laparotomy

胆结石是普外科常见的一种结石疾病，患者一旦患病非常容易诱发诸多并发症，如胆囊穿孔、胆囊炎等，临床症状多伴有恶心呕吐、腹部疼痛，胆结石多发于女性，若未能及时治疗，会严重威胁患者的生命安全[1]。目前临床常用的治疗胆结石的方法是手术治疗，腹腔镜胆囊切除术、传统开腹手术是常用的手术方式[2]。传统开腹手术存在较多缺陷，如术后恢复慢、术后并发症多、术中出血量多、手术切口长、创伤性大等，而腹腔镜胆囊切除术术后并发症较少、能够确保徹底清除结石、对人体腹腔组织的损伤也较小，属于微创手术[3]。本研究探讨采用腹腔镜胆囊切除术治疗胆结石患者的有效性及对患者并发症发生的影响，现报道如下。……