本文選題：膽總管結(jié)石 + 腹腔鏡膽囊切除術(shù)��； 參考：《新疆醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較分析腹腔鏡膽總管探查術(shù)(LCBDE)聯(lián)合腹腔鏡膽囊切除術(shù)(LC)與內(nèi)鏡逆行胰膽管造影(ERCP)/內(nèi)鏡下括約肌切開術(shù)(EST)聯(lián)合LC治療膽囊結(jié)石合并膽總管結(jié)石的臨床療效。方法:回顧性分析新疆醫(yī)科大學(xué)第二附屬醫(yī)院2013年12月~2016年12月資料完整的進(jìn)行微創(chuàng)手術(shù)治療膽囊結(jié)石合并膽總管結(jié)石的患者共87例,其中36例行LCBDE+LC手術(shù)治療,51例行ERCP/EST+LC手術(shù)治療,對(duì)兩種治療方法的手術(shù)成功率、中轉(zhuǎn)開腹率、手術(shù)時(shí)間、術(shù)后肛門排氣時(shí)間、住院時(shí)間、住院費(fèi)用、術(shù)后早期并發(fā)癥等臨床資料進(jìn)行比較,計(jì)量資料2組間比較采用t檢驗(yàn);計(jì)數(shù)資料2組間比較采用2?檢驗(yàn)。結(jié)果:LCBDE+LC組手術(shù)成功率91.67%(33/36),中轉(zhuǎn)開腹率8.35%(3/36),術(shù)后并發(fā)膽漏3例。ERCP/EST+LC手術(shù)成功率92.16%(47/51)、中轉(zhuǎn)開腹率7.84%(4/51),術(shù)后并發(fā)胰腺炎9例、出血2例。比較兩組手術(shù)成功率、中轉(zhuǎn)開腹率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。ERCP/EST+LC組術(shù)后急性胰腺炎的發(fā)生率高于LC+LCBDE組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而術(shù)后出血、膽漏的發(fā)生率兩組相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。LCBDE+LC組在手術(shù)時(shí)間、住院時(shí)間、住院費(fèi)用等方面低于ERCP/EST+LC組,且差異具有統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論:LCBDE+LC和ERCP/EST+LC均是治療膽囊結(jié)石合并膽總管結(jié)石的有效微創(chuàng)療法,LCBDE+LC組更具有手術(shù)時(shí)間短、住院時(shí)間短且住院費(fèi)用低等優(yōu)點(diǎn),因此對(duì)于乳頭功能良好經(jīng)濟(jì)困難的病人,應(yīng)首選LCBDE+LC。但是總體應(yīng)根據(jù)患者的不同情況,結(jié)合術(shù)者的技術(shù)和條件,合理的選擇微創(chuàng)治療方案。
[Abstract]:Objective: to compare the clinical effects of laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) and endoscopic retrograde cholangiopancreatography (ERCP) / endoscopic sphincterotomy (EST) in the treatment of cholecystolithiasis with choledocholithiasis. Methods: 87 cases of cholecystolithiasis complicated with choledocholithiasis were retrospectively analyzed in the second affiliated Hospital of Xinjiang Medical University from December 2013 to December 2016. Among them, 36 cases were treated with LCBDE LC and 51 cases were treated with ERCP / EST LC. The successful rate of operation, the rate of conversion to laparotomy, the time of operation, the time of anal exhaust after operation, the cost of hospitalization, and so on. The clinical data such as early postoperative complications were compared, the measurement data were compared by t test between two groups, and the count data between two groups were compared by 2? Examination. Results the operative success rate was 91.67% (33 / 36), the conversion rate was 8.35% (3 / 36), the success rate was 92.16% (47 / 51), the conversion rate was 7.84% (4 / 51), 9 cases were complicated with pancreatitis and 2 cases were bleeding. There was no significant difference in the conversion rate between the two groups (P0.05). The incidence of acute pancreatitis in ERCP / EST LC group was higher than that in LC LCBDE group (P0.05). There was no significant difference in the incidence of postoperative bleeding and bile leakage between the two groups (P0.05) .LCBDE LC group was lower than ERCP / EST LC group in operation time, hospitalization cost, and the difference was statistically significant (P 0.05). Conclusion both the% LCBDE LC and ERCP / EST LC are effective minimally invasive therapy for cholecystolithiasis complicated with choledocholithiasis. The LCBDE LC group has the advantages of shorter operation time, shorter hospitalization time and lower hospitalization cost. LCBDE LC. However, according to the different conditions of the patients, combined with the technique and conditions of the operator, the minimally invasive treatment should be reasonably selected.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.42

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本文編號(hào)：2099948