發(fā)布時(shí)間：2018-04-11 12:32

  本文選題：膽總管結(jié)石 + 保留膽囊��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:研究不同微創(chuàng)方式治療膽總管結(jié)石不伴有膽囊結(jié)石的臨床效果。方法:回顧性分析我院2013年9月至2014年12月期間收治的膽總管結(jié)石不伴膽囊結(jié)石手術(shù)治療的83例患者的臨床資料,按其手術(shù)方式分為4組。A組21例:行腹腔鏡下膽總管切開取石一期縫合術(shù),術(shù)中保留膽囊;B組25例:行腹腔鏡下膽囊切除+腹腔鏡下膽總管切開取石一期縫合術(shù);C組18例:腹腔鏡下膽囊切除術(shù)+腹腔鏡下膽總管切開取石術(shù)+T管引流術(shù);D組19例:內(nèi)鏡下十二指腸乳頭括約肌切開取石術(shù)。對比觀察4組患者的術(shù)前指標(biāo)、術(shù)中治療、術(shù)后恢復(fù)情況等相關(guān)臨床指標(biāo)。結(jié)果:A組21例患者均完成保留膽囊的腹腔鏡下膽總管切開取石一期縫合術(shù),術(shù)中未切除膽囊,且均未放置T管,術(shù)后未出現(xiàn)膽瘺、結(jié)石殘留等并發(fā)癥,術(shù)后隨訪24個(gè)月以上均未見結(jié)石復(fù)發(fā);B組25例患者均完成腹腔鏡下膽總管切開取石一期縫合術(shù)同時(shí)切除膽囊,術(shù)中也均未放置T管,術(shù)后1例患者出現(xiàn)膽瘺,1例患者術(shù)后第18月時(shí)復(fù)發(fā)膽總管結(jié)石;C組18例均完成腹腔鏡下膽囊切除術(shù)+腹腔鏡下膽總管切開取石術(shù)+T管引流術(shù),術(shù)后2例患者發(fā)現(xiàn)膽道殘余結(jié)石,1例患者術(shù)后24月時(shí)復(fù)發(fā)膽總管結(jié)石;患者D組19例患者均完成內(nèi)鏡下十二指腸乳頭括約肌切開取石術(shù),術(shù)后2例患者出現(xiàn)輕型胰腺炎,1例在術(shù)后第9個(gè)月時(shí)出現(xiàn)反流性膽管炎,術(shù)后18月時(shí)復(fù)發(fā)膽總管結(jié)石。4組患者術(shù)前白細(xì)胞水平、術(shù)前白蛋白水平相似,差異無統(tǒng)計(jì)學(xué)意義(P均0.05);而A組術(shù)前B超檢查膽囊壁厚度最薄,與其他三組相比差異有統(tǒng)計(jì)學(xué)意義(P均0.05);在術(shù)前膽紅素水平方面,C組最高(P0.05)。4組患者的結(jié)石發(fā)生情況方面:A組單發(fā)結(jié)石的例數(shù)更多(P0.05);結(jié)石]
頓情況方面,A組例數(shù)最少(P0.05);C組住院時(shí)間最長、手術(shù)時(shí)間(P0.05);在術(shù)中出血量、總住院費(fèi)用方面4組差異無統(tǒng)計(jì)學(xué)意義(P均0.05)。結(jié)論:4種微創(chuàng)方式治療膽總管結(jié)石不伴膽囊結(jié)石各有利弊,臨床需根據(jù)患者的情況采用個(gè)體化方式進(jìn)行選擇;對于膽總管結(jié)石不伴有膽囊結(jié)石且膽囊功能良好的患者,在滿足手術(shù)適應(yīng)癥時(shí)行保留膽囊的腹腔鏡下膽總管切開取石一期縫合術(shù)是安全、有效的。
[Abstract]:Objective: to study the clinical effect of different minimally invasive treatment of choledocholithiasis without cholecystolithiasis.Methods: the clinical data of 83 patients with choledocholithiasis without cholecystolithiasis treated in our hospital from September 2013 to December 2014 were retrospectively analyzed.According to its operation mode, 21 cases were divided into 4 groups. Group A: laparoscopic choledocholithotomy and primary suture.Group B 25 cases: laparoscopic cholecystectomy laparoscopic choledocholithotomy with primary suture and group C 18 cases with laparoscopic cholecystectomy laparoscopic choledocholithotomy T tube drainageGroup D: endoscopic sphincterotomy of duodenal papilla.The clinical indexes such as preoperative index, intraoperative treatment and postoperative recovery were compared among the 4 groups.Results 21 patients in group A underwent laparoscopic choledocholithotomy and primary suture of choledocholithiasis without cholecystectomy, and no T-tube was placed. There were no complications such as biliary fistula, residual stone, and so on.All the 25 patients in group B underwent laparoscopic choledocholithotomy and cholecystectomy with cholecystectomy, and no T-tube was placed during the operation.Postoperative biliary fistula occurred in 1 patient. In group C, 18 patients underwent laparoscopic cholecystectomy and choledocholithotomy with T-tube drainage, 18 patients suffered from recurrent choledocholithiasis at the 18th month after operation, and 18 patients underwent laparoscopic cholecystectomy with choledocholithotomy.After operation, 1 patient with bile duct residual stone and 19 patients with choledocholithiasis recurred 24 months after operation, 19 patients in group D underwent endoscopic sphincterotomy of duodenal papillary sphincter.One patient developed reflux cholangitis at the 9th month after operation, and the preoperative leukocyte and albumin levels were similar in the group of 4 patients with recurrent choledocholithiasis at 18 months after operation.There was no significant difference in the thickness of gallbladder wall between two groups (P < 0.05), but the thickness of gallbladder wall was the thinnest in group A by B-ultrasound before operation.Compared with the other three groups, the difference was statistically significant (P < 0.05); in terms of preoperative bilirubin level, the highest level of bilirubin was found in group C (P 0.05) and the incidence of single stone in group A was more than that in group A (P 0.05).The length of stay in group C was the longest.There was no significant difference in blood loss and total hospitalization cost among the four groups (P < 0.05).Conclusion the four minimally invasive methods for the treatment of choledocholithiasis without gallstone have their advantages and disadvantages, and the patients with choledocholithiasis without cholecystolithiasis and with good cholecystolithiasis should be selected by individualized method according to the situation of the patients with choledocholithiasis.Laparoscopic choledocholithotomy and primary suture for choledocholithotomy is safe and effective.
【學(xué)位授予單位】：南昌大學(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)：1736058