本文選題：膽總管結(jié)石　切入點：膽囊切除術(shù)　出處：《中國全科醫(yī)學(xué)》2017年02期

【摘要】：目的 探討膽總管結(jié)石伴膽囊結(jié)石的最佳腹腔鏡治療方法。方法 選取2014年1月—2015年6月包頭醫(yī)學(xué)院第二附屬醫(yī)院收治的膽總管結(jié)石伴膽囊結(jié)石患者254例,患者行膽總管探查術(shù),根據(jù)結(jié)石情況分為腹腔鏡下經(jīng)膽囊管取石術(shù)(LTSE)組和腹腔鏡下膽總管切開取石術(shù)(LCBDE)組,LCBDE組患者經(jīng)膽總管清除結(jié)石手術(shù)后被隨機(jī)分配接受膽管一期縫合(一期縫合亞組)或T管引流(T管引流亞組)。比較LTSE組和LCBDE組患者結(jié)石清除率、并發(fā)癥發(fā)生情況以及住院費用、住院時間等。結(jié)果 14例患者轉(zhuǎn)行開放性手術(shù),172例患者接受LTSE,68例患者接受LCBDE。LCBDE患者中,一期縫合34例,T管引流34例。LTSE組和LCBDE組性別、年齡、急性膽囊炎、結(jié)石清除率比較,差異均無統(tǒng)計學(xué)意義(P0.05);LTSE組結(jié)石數(shù)量、結(jié)石直徑小于LCBDE組,手術(shù)時間、住院費用、住院時間短于LCBDE組(P0.05)。一期縫合亞組和T管引流亞組性別、年齡、急性膽囊炎、結(jié)石數(shù)量、結(jié)石直徑、結(jié)石清除率比較,差異均無統(tǒng)計學(xué)意義(P0.05);一期縫合亞組手術(shù)時間、住院費用、住院時間短于T管引流亞組(P0.05)。LTSE組膽管并發(fā)癥發(fā)生率低于LCBDE組(χ~2=6.461,P=0.011);兩組其他并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ~2=3.682,P=0.055);LTSE組總并發(fā)癥發(fā)生率低于LCBDE組(χ~2=11.332,P=0.001)。結(jié)論 對于膽總管結(jié)石伴膽囊結(jié)石患者,LTSE應(yīng)是首選治療,較LCBDE更安全有效,費用低。對于行LCBDE者,一期縫合簡單易行,可替代T管引流。
[Abstract]:Objective to explore the best laparoscopic treatment of choledocholithiasis with cholecystolithiasis.Methods 254 patients with choledocholithiasis associated with cholecystolithiasis were selected from January 2014 to June 2015 in the second affiliated Hospital of Baotou Medical College.According to the stone condition, the patients in the LCBDE group were randomly assigned to undergo primary suture of the bile duct after choledocholithiasis under laparoscopic transhepatic cholecystolithiasis (LTSE) and laparoscopic choledocholithotomy (LCBDE).Group B) or T-tube drainage group (T tube drainage subgroup).The stone clearance rate, complications, hospitalization cost and hospitalization time were compared between LTSE group and LCBDE group.Results among 14 patients undergoing open operation, 172 patients received LCBDE.LCBDE, 34 patients underwent primary suture with T tube drainage. Sex, age, acute cholecystitis, stone clearance rate were compared between LTSE group and LCBDE group.There was no significant difference in the number of stones, the diameter of stones was smaller than that in LCBDE group, the operation time, hospitalization cost and hospitalization time were shorter than those in LCBDE group.There were no significant differences in sex, age, acute cholecystitis, stone number, stone diameter, stone clearance rate between primary suture subgroup and T tube drainage subgroup (P 0.05).浣忛櫌鏃墮棿鐭簬T綆″紩嫻佷簹緇，

本文編號：1714081