【摘要】：目的：分析在對(duì)于膽囊結(jié)石患者在實(shí)施治療的過(guò)程中,通過(guò)對(duì)于患者進(jìn)行腹腔鏡聯(lián)合膽道鏡保膽取石手術(shù)和常規(guī)的腹腔鏡膽囊切除術(shù)對(duì)于患者的治療效果以及相關(guān)安全性的比較。方法：收集我院在2012.3月-2013.2月間收治的使用影像學(xué)方法進(jìn)行確診為膽囊結(jié)石的患者,患者的數(shù)量為80例。按照患者在臨床手術(shù)治療過(guò)程中對(duì)于患者使用的不同治療方法,將所有的患者分為觀察組以及對(duì)照組,每組患者在數(shù)量方面,均為40例。對(duì)照組患者使用常規(guī)的腹腔鏡膽囊切除術(shù)(Laparoscopic cholecystectomy, LC)的方法實(shí)施治療。觀察組患者使用腹腔鏡聯(lián)合膽道鏡的保膽取石術(shù)(Laparoscopic choledochoscopy-assisted removal of cholecys cithias, LRCL)對(duì)于患者實(shí)施治療,對(duì)比兩組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后腸蠕動(dòng)恢復(fù)時(shí)間、術(shù)后飲食恢復(fù)時(shí)間、住院時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥發(fā)生率、不良反應(yīng)發(fā)生率以及術(shù)后復(fù)發(fā)率。結(jié)果：實(shí)驗(yàn)組(保膽取石組)和對(duì)照組(腹腔鏡膽囊切除組)均無(wú)中轉(zhuǎn)開(kāi)腹病例,均取得很好的治療效果,無(wú)嚴(yán)重的并發(fā)癥發(fā)生,保膽取石組與腹腔鏡膽囊切除術(shù)組的比較,術(shù)中出血量少、術(shù)后并發(fā)癥發(fā)生率低、不良反應(yīng)發(fā)生率低,但手術(shù)時(shí)間稍長(zhǎng),兩組患者的術(shù)后腸蠕動(dòng)恢復(fù)時(shí)間、術(shù)后飲食恢復(fù)時(shí)間、住院時(shí)間、住院費(fèi)用無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),對(duì)保膽取石組進(jìn)行相應(yīng)的隨訪后我們發(fā)現(xiàn),術(shù)后1年復(fù)查膽囊結(jié)石復(fù)發(fā)率為2.5%,術(shù)后2年復(fù)查膽囊結(jié)石復(fù)發(fā)率為5%,符合正常人群的膽囊結(jié)石患病率。。結(jié)論：腹腔鏡聯(lián)合膽道鏡保膽取石術(shù)治療膽囊結(jié)石,能夠顯著的降低患者的術(shù)中出血量、并發(fā)癥以及術(shù)后不良反應(yīng)等情況,不增加手術(shù)完成后的腸蠕動(dòng)恢復(fù)時(shí)間、飲食恢復(fù)時(shí)間、住院時(shí)間、以及患者的治療所需費(fèi)用,是治療膽囊結(jié)石的一種有效治療手段,在理論及技術(shù)上安全、可行,符合微創(chuàng)治療觀念,保留了有功能的膽囊,提高了生活質(zhì)量,滿(mǎn)足了有保膽意識(shí)的病人,可以在有條件的醫(yī)院中開(kāi)展此技術(shù)。
[Abstract]:Objective: to analyze the course of treatment for patients with gallstone. The therapeutic effect and related safety of laparoscopic choledochoscopy combined with choledochoscope choledocholithotomy and conventional laparoscopic gallbladder resection were compared. Methods: 80 patients with gallstones were diagnosed by imaging from March 2012.3 to February 2013.The number of patients was 80. According to the different treatment methods used by the patients in the course of clinical operation, all the patients were divided into observation group and control group, and the number of patients in each group was 40 cases. The patients in the control group were treated with conventional laparoscopic Cholecystectomy (Laparoscopic cholecystectomy, LC). The patients in the observation group were treated with laparoscopic choledochoscopy (Laparoscopic choledochoscopy-assisted removal of cholecys cithias, LRCL). The operation time, the amount of bleeding during operation, the recovery time of intestinal peristalsis and the recovery time of diet between the two groups were compared. Length of stay, cost of hospitalization, incidence of postoperative complications, incidence of adverse reactions and recurrence rate. Results: there were no cases of conversion to laparotomy in the experimental group (choledocholithotomy group) and the control group (laparoscopic Cholecystectomy group). There were no serious complications in the experimental group (cholelithiasis group) and the control group (laparoscopic Cholecystectomy group). The amount of intraoperative bleeding was less, the incidence of postoperative complications was low, and the incidence of adverse reactions was low, but the operation time was a little longer. The recovery time of intestinal peristalsis, the recovery time of postoperative diet and the time of hospitalization in the two groups. There was no significant difference in hospitalization expenses (P 0.05). After the corresponding follow-up of cholelithiasis group, we found that the recurrence rate of gallstone was 2.5% in 1 year and 5% in 2 years after operation. Consistent with the prevalence of gallstones in the normal population.. Conclusion: laparoscopic choledochoscopy combined with choledochoscopy in the treatment of gallstones can significantly reduce the amount of intraoperative bleeding, complications and postoperative adverse reactions, and do not increase the recovery time of intestinal peristalsis after operation. Diet recovery time, hospitalization time and the cost of patients' treatment are an effective treatment for gallstones. It is safe and feasible in theory and technology, in line with the concept of minimally invasive treatment, and retains the functional gallbladder. This technology can be carried out in conditional hospitals by improving the quality of life and satisfying the patients with gallbladder awareness.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R657.42

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