【摘要】：研究目的:有關(guān)肝膽管結(jié)石的治療方式,主要有傳統(tǒng)的開腹手術(shù)與近年來逐漸被臨床更多運(yùn)用的微創(chuàng)手術(shù)治療兩種方式。總體來講微創(chuàng)治療在膽石癥方面已更為廣泛應(yīng)用于臨床,尤其是在膽囊切除方面。那么,對于肝膽管結(jié)石的微創(chuàng)治療因手術(shù)難度增加,對病例病變范圍有所選擇性(一般為慢性,年齡不能過高,基礎(chǔ)疾病較少)及微創(chuàng)特有的電刀副損傷及CO2氣腹對患者的影響是否優(yōu)于傳統(tǒng)開腹手術(shù)治療方式。這些提示我們從一系列相關(guān)指標(biāo)(手術(shù)時間、術(shù)中出血量、術(shù)后引流管留置時間、術(shù)后并發(fā)癥發(fā)生率、結(jié)石復(fù)發(fā)率、殘石率)中,探究不同手術(shù)方式治療肝膽管結(jié)石的臨床療效。研究方法:1.擇取山西醫(yī)科大學(xué)第二醫(yī)院普外科2012年6月~2014年9月收治的64例肝膽管結(jié)石患者的病歷資料。2.按照手術(shù)方式不同分成兩組,對照組實(shí)施傳統(tǒng)手術(shù)治療,實(shí)驗(yàn)組實(shí)施微創(chuàng)手術(shù)治療,對比兩組臨床治療效果。3.通過統(tǒng)計學(xué)分析計算比較2組間手術(shù)時間、術(shù)中出血量、術(shù)后引流管留置時間,并詳細(xì)分析各組術(shù)后并發(fā)癥發(fā)生率,結(jié)石復(fù)發(fā)率及殘石率。4.最后,利用卡方檢驗(yàn)分析微創(chuàng)手術(shù)治療肝膽管結(jié)石是否優(yōu)于傳統(tǒng)手術(shù)。研究結(jié)果:1.實(shí)驗(yàn)組手術(shù)時間(min:120.28±11.67 vs 141.36±13.52)、術(shù)中出血量(ml:79.35±9.71 vs 146.34±12.25)及術(shù)后引流管留置時間(d:3.23±1.21 vs4.93±3.34)均短于對照組。這些觀察指標(biāo)的降低能反映手術(shù)的安全性。2.實(shí)驗(yàn)組術(shù)后并發(fā)癥發(fā)生率(0 vs 18.75%)、結(jié)石復(fù)發(fā)率(0 vs 21.87%)、殘石率(6.25%vs 25.006.25%)均低于對照組,差異具有顯著統(tǒng)計學(xué)意義(P0.05)。而這些觀察指標(biāo)下降則是對治療效果的一個評價。研究結(jié)論:1.通過本實(shí)驗(yàn)觀察研究,得出微創(chuàng)手術(shù)的手術(shù)時間短、術(shù)中出血少、術(shù)后引流管留置時間短,術(shù)后并發(fā)癥發(fā)生率低,結(jié)石復(fù)發(fā)率小、殘石率低。微創(chuàng)手術(shù)治療肝膽管結(jié)石臨床療效確切,安全指數(shù)高;2.微創(chuàng)手術(shù)治療肝膽管結(jié)石疾病具有一定優(yōu)勢,臨床上應(yīng)引起足夠重視,但應(yīng)注意提高手術(shù)操作熟練度、避免微創(chuàng)手術(shù)特有的副損傷。
[Abstract]:Objective: the treatment of hepatolithiasis mainly includes traditional open surgery and minimally invasive surgery, which has been used more and more in clinical practice in recent years. Generally speaking, minimally invasive therapy has been widely used in cholelithiasis, especially in cholecystectomy. So, the minimally invasive treatment for hepatolithiasis is more difficult to operate on and selective for the range of lesions (usually chronic, not too old). The effect of electrosurgical accessory injury and CO2 pneumoperitoneum on patients is better than that of traditional open surgery. These suggest that in a series of related indicators (operative time, intraoperative bleeding, postoperative drainage tube indwelling time, postoperative complication rate, stone recurrence rate, residual stone rate), To explore the clinical efficacy of different surgical methods in the treatment of hepatolithiasis. Research method: 1. The medical records of 64 patients with hepatolithiasis admitted from June 2012 to September 2014 in the Department of General surgery of the second Hospital of Shanxi Medical University were collected. According to the different operation methods, the control group was treated with traditional operation, the experimental group was treated with minimally invasive surgery, and the two groups were compared with each other. The time of operation, the amount of intraoperative bleeding and the time of drainage tube indwelling were calculated and compared by statistical analysis. The incidence of postoperative complications, the recurrence rate of stone and the rate of residual stone were analyzed in detail. Finally, chi-square test is used to analyze whether minimally invasive surgery is superior to traditional surgery in the treatment of hepatolithiasis. The result of the study was: 1. The operative time (min:120.28 鹵11.67 vs 141.36 鹵13.52), intraoperative bleeding volume (ml:79.35 鹵9.71 vs 146.34 鹵12.25) and postoperative drainage tube retention time (d: 3.23 鹵1.21 vs4.93 鹵3.34) in the experimental group were shorter than those in the control group. The decrease of these indexes can reflect the safety of the operation. 2. The incidence of postoperative complications (0 vs 18.75%), the recurrence rate of stones (0 vs 21.87%) and the residual stone rate (6.25%vs 25.006.25%) in the experimental group were significantly lower than those in the control group (P0.05). The decline in these observational indicators is an assessment of therapeutic effectiveness. Conclusion: 1. The results showed that the operation time was short, the bleeding was less, the time of drainage tube indwelling was short, the incidence of postoperative complications was low, the recurrence rate of stone was small, and the rate of residual stone was low. Minimally invasive surgery was effective in the treatment of hepatolithiasis with a high safety index of 2. Minimally invasive surgery has some advantages in the treatment of hepatolithiasis, which should be paid enough attention to clinically, but it should be paid more attention to improve the skill of operation and avoid the special collateral injury of minimally invasive surgery.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.4

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