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腹腔镜手术治疗胃大部切除术后胆总管结石的效果观察
Clinical effect of laparoscopic surgery in treatment of common bile duct stones after subtotal gastrectomy
文章发布日期:2017年07月07日  来源:  作者:雷霆  点击次数:260次  下载次数:32次

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【摘要】:目的 探讨腹腔镜手术治疗胃大部切除术后胆总管结石的安全性和可行性。方法 回顾性分析郑州大学附属洛阳中心医院2010年1月-2016年10月收治的46例行手术治疗的胃大部切除术胆总管结石患者(均合并胆囊结石)的临床资料,其中25例行腹腔镜胆囊切除+胆总管探查术(腹腔镜组),21例行开腹胆囊切除+胆总管探查术(开腹组)。比较2组患者手术相关情况及术后并发症。2组间计量资料比较采用t检验,计数资料比较采用χ2检验。结果 2组患者均无围手术期死亡病例,腹腔镜组2例(8.0%)中转开腹。腹腔镜组与开腹组相比,术后下床活动时间[(1.2±0.6)d vs (2.4±1.2) d)]、术后肛门排气时间[(1.8±0.5) d vs(2.8±0.8) d]及术后住院时间[(5.2±1.1) d vs(7.5±2.3) d]差异均有统计学意义(t值分别为4.395﹑5.168﹑4439,P值均<0.001)。2组患者的手术时间、手术出血量、住院费用、T管留置和结石残留率比较,差异均无统计学意义(P值均>0.05)。腹腔镜组术后2例患者出现并发症,发生率为8.0%,开腹组术后3例患者出现并发症,发生率为14.3%,差异无统计学意义(P=0.495)。结论 腹腔镜手术治疗胃大部切除术后胆总管结石是安全可行的,且较开腹手术而言,有明显的微创优势。
【Abstract】:Objective To investigate the safety and feasibility of laparoscopic surgery in the treatment of common bile duct stones after subtotal gastrectomy. Methods A retrospective analysis was performed for the clinical data of 46 patients with gallstones and common bile duct stones after subtotal gastrectomy who underwent surgical treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to October 2016. Among these patients, 25 underwent laparoscopic cholecystectomy+common bile duct exploration (laparoscopic group), and 21 underwent open cholecystectomy+common bile duct exploration (open group). The surgical conditions and postoperative complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results No patients died during the perioperative period and 2 patients (8.0%) in the laparoscopic group were converted to open surgery. There were significant differences between the laparoscopic group and the open group in time to ambulation after surgery (1.2±0.6 d vs 2.4±1.2 d, t=4.395, P<0.001), time to passage of gas by anus after surgery (1.8±0.5 d vs 2.8±0.8 d, t=5.168, P<0.001), and length of postoperative hospital stay (5.2±1.1 d vs 7.5±2.3 d, t=4.439, P<0.001). There were no significant differences between the two groups in time of operation, intraoperative blood loss, hospital costs, T tube placement, and rate of residual stones (all P>0.05). After surgery, 2 patients (8.0%) in the laparoscopic group and 3 (14.3%) in the open group experienced complications, and there was no significant difference between the two groups (P=0.495). Conclusion Laparoscopic surgery is safe and feasible in the treatment of common bile duct stones after subtotal gastrectomy and has the advantages of minimally invasive surgery.
【关键字】:胆总管结石;胆囊结石病;腹腔镜检查;治疗结果
【Key words】:choledocholithiasis; cholecystolithiasis; laparoscopy; treatment outcome
【引证本文】:雷霆. 腹腔镜手术治疗胃大部切除术后胆总管结石的效果观察[J]. 临床肝胆病杂志, 2017, 33(8): 1510-1513.

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