摘要
目的比较腹腔镜与开腹胆总管探查术治疗复杂性肝胆管结石的疗效及安全性。方法选取2014年3月至2017年3月长治医学院附属和济医院收治的复杂性肝胆管结石患者150例,按照随机数字表法分成观察组和对照组,每组75例。对照组予以常规开腹胆总管探查术治疗,观察组采用腹腔镜胆总管探查术治疗。比较两组各项手术指标水平、并发症发生率、复发率情况,术前与术后1个月胆红素水平、术前与术后6个月生活质量情况。结果观察组手术时间、术中失血量、胃肠道恢复时间、住院时间分别为(154.23±20.47)min、(59.12±8.92)mL、(19.65±3.48)h、(11.48±2.48)d,低于对照组的(217.59±30.59)min、(87.24±10.17)mL、(27.87±6.12)h、(16.51±4.28)d(t=14.908、18.002、10.112、8.806,均P<0.05)。术后1个月观察组总胆红素、直接胆红素、间接胆红素水平分别为(14.38±3.69)μmol/L、(3.39±1.17)μmol/L、(11.45±3.02)μmol/L,低于对照组的(28.43±4.31)μmol/L、(6.31±2.08)μmol/L、(21.05±4.87)μmol/L(t=21.445、10.596、14.508,均P<0.05)。观察组术后并发症发生率及复发率为2.67%、0.00%,低于对照组的14.67%、10.67%(χ^2=6.822、8.451,均P<0.05)。术后6个月观察组社会活动、精力、躯体活动、睡眠情绪评分分别为(4.72±0.85)分、(13.25±1.21)分、(3.81±0.51)分、(6.52±2.44)分,高于对照组的(2.65±0.61)分、(8.09±0.68)分、(1.95±0.52)分、(3.98±2.38)分(t=10.513、11.605、12.604、6.454,均P<0.05)。结论腹腔镜胆总管探查术治疗复杂性肝胆管结石的效果确切,且有效改善胆红素水平,提高患者生活质量,安全性较好。
Objective To study the efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis.Methods From March 2014 to March 2017,150 cases of complicated hepatolithiasis who were treated in Heji Hospital Affiliated to Changzhi Medical College were selected.The patients were divided into observation group and control group according to random number table,with 75 cases in each group.The control group was treated with conventional open abdominal common bile duct exploration,and the observation group was treated by laparoscopic choledochal exploration.The levels of surgical indicators,the incidence of complications,the recurrence rate,the bilirubin level before operation and 1 month after operation,and the quality of life before operation and 6 months after operation were compared between the two groups.Results The operative time,intraoperative blood loss,gastrointestinal recovery time and hospitalization time in the observation group were(154.23±20.47)min,(59.12±8.92)mL,(19.65±3.48)h,(11.48±2.48)d,respectively,which were significantly lower than those in the control group[(217.59±30.59)min,(87.24±10.17)mL,(27.87±6.12)h,(16.51±4.28)d](t=14.908,18.002,10.112,8.806,all P<0.05).The levels of total bilirubin,direct bilirubin and indirect bilirubin in the observation group at 1 month after operation were(14.38±3.69)μmol/L,(3.39±1.17)μmol/L,(11.45±3.02)μmol/L,which were significantly lower than those in the control group[(28.43±4.31)μmol/L,(6.31±2.08)μmol/L,(21.05±4.87)μmol/L](t=21.445,10.596,14.508,all P<0.05).The incidence rate of complications and recurrence rate of the observation group at 6 months after operation were 2.67%and 0.00%,respectively,which were lower than 14.67%and 10.67%of the control group(χ^2=6.822,8.451,all P<0.05).The scores of social activities,energy,physical activity and sleep mood in the observation group at 6 months after operation were(4.72±0.85)points,(13.25±1.21)points,(3.81±0.51)points,(6.52±2.44)points,respectively,which were higher than those in the control group[(2.65±0.61)points,(8.09±0.68)points,(1.95±0.52)points,(3.98±2.38)points](t=10.513,11.605,12.604,6.454,all P<0.05).Conclusion Laparoscopic choledochal exploration is effective in the treatment of complicated hepatolithiasis,and it can improve the level of bilirubin and improve the quality of life,the safety is good.
作者
刘军廷
Liu Junting(Department of Hepatobiliary General Surgery,Heji Hospital Affiliated to Changzhi Medical College,Changzhi,Shanxi 046000,China)
出处
《中国基层医药》
CAS
2019年第16期1982-1985,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
胆囊结石病
腹腔镜检查
胆红素
疗效比较研究
Cholecystolithiasis
Laparoscopy
Bilirubin
Comparative Effectiveness Research
