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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 409 -411. doi: 10.3877/cma.j.issn.1674-3946.2019.04.028

所属专题： 文献；

论著

三种术式治疗再发性胆总管结石的疗效及安全性比较
徐降兴1, 杨小红1, 熊小勇1, 王建惠1, 唐金绍1, 徐晓芸1,†()   
  1. 1. 353000　福建南平，南平市九二医院普外科
  • 收稿日期:2018-08-23 出版日期:2019-08-26
  • 通信作者: 徐晓芸

Comparison of Efficacy and Safety of Three Kinds of Surgical Treatment for Recurrent Bile Duct Stones

Xiangxing Xu1, Xiaohong Yang1, Xiaoyong Xiong1, Jianhui Wang1, Jinshao Tang1, Xiaoyun Xu1,†()   

  1. 1. Nanping No. 92 Hospital General Surgery Fujian Nanping 353000
  • Received:2018-08-23 Published:2019-08-26
  • Corresponding author: Xiaoyun Xu
  • About author:
    Corresponding author: Xu Xiaoyun, Email:
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引用本文：

徐降兴, 杨小红, 熊小勇, 王建惠, 唐金绍, 徐晓芸. 三种术式治疗再发性胆总管结石的疗效及安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(04): 409-411.

Xiangxing Xu, Xiaohong Yang, Xiaoyong Xiong, Jianhui Wang, Jinshao Tang, Xiaoyun Xu. Comparison of Efficacy and Safety of Three Kinds of Surgical Treatment for Recurrent Bile Duct Stones[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(04): 409-411.

目的

比较腹腔镜结合内镜、腹腔镜结合十二指肠镜和开腹术治疗再发性胆总管结石的疗效及安全性。

方法

回顾性分析2014年4月至2018年3月161例再发性胆总管结石患者的临床资料，分为A组(腹腔镜联合内镜治疗，n＝67例)、B组(腹腔镜联合十二指肠镜镜治疗，n＝63例)、C组(传统开腹术，n＝31例)，数据处理应用统计学软件SPSS18.0完成，手术相关指标的比较采用单因素方差分析，两两比较采用LSD－t检验；术后并发症发生率、中转开腹率等采用χ2检验；P<0.05为差异有统计学意义。

结果

A组手术时间长于B组和C组(P<0.05)，A组和B组的术中出血量和排气时间均低于C组(P<0.05)，B组的住院时间低于A组和C组(P<0.05)。A组并发症发生率最低，C组最高，差异具有统计学意义(P<0.05)。A组患者结石直径和结石数目均高于B组患者(P<0.05)，A组和B组中转开腹率的差异不明显(P>0.05)。

结论

腹腔镜结合内镜与腹腔镜结合十二指肠镜治疗再发性胆总管结石的疗效及安全性均优于开腹治疗，值得推广应用。

关键词: 胆总管结石, 复发, 腹腔镜, 十二指肠镜, 疗效比较研究
Objective

To compare the efficacy and safety of laparoscopy combined with biliary endoscopy, laparoscopy combined with duodenoscopy and traditional laparotomy surgery for the treatment of recurrent common bile duct stones.

Methods

Clinical data of 161 patients with common bile duct stones treated in our hospital were collected and divided into group A (laparoscopic combined with endoscopic treatment, n=67 cases), group B (laparoscopic combined with duodenoscopy, n=63 cases) and group C (traditional laparotomy, n=31 cases), the clinical data of the three groups of patients were analyzed and compared using SPSS18.0 statistics software. In this study, the comparison of surgical related indexes was performed by one-way analysis of variance, and multiple comparisons were performed by LSD-t test. The postoperative complication rate and conversion rate were calculated by χ2 test. P<0.05 was considered statistically significant.

Results

The operation time in group A was longer than that in group B and group C (P<0.05). The intraoperative blood loss and exhaust time in group A and B were lower than those in group C (P<0.05). The hospitalization time in group B was lower than those in group A and group C (P<0.05). The incidence of complication was the lowest in group A and the highest in group C, the difference was statistically significant (P<0.05). The stone diameter and number of stones in group A were higher than those in group B (P<0.05). There was no significant difference in conversion rates between group A and group B (P>0.05).

Conclusion

The efficacy and safety of laparoscopic combined with biliary endoscopy and laparoscopy combined with duodenoscopy in the treatment of recurrent common bile duct stones are better than traditional laparotomy, it was worthy of promotion and application.

Key words: Choledocholithiasis, Recurrence, Laparoscopes, Duodenoscopes, Comparative effectiveness research
表1 161例再发性胆总管结石不同术式三组患者基本资料比较(±s)
组别 例数 年龄(岁) 性别(男/女) 病程(月)
A组 67 48.6±12.3 20/47 27.6±11.4
B组 63 49.2±11.6 22/41 29.6±10.7
C组 31 51.1±10.8 12/19 30.1±12.8
χ2/F值 ? 1.357 0.834 1.262
P值 ? >0.05 >0.05 >0.05
组别 例数 发病时间(h) 右上腹痛(例) 发热(例)
A组 67 19.7±8.4 63 38
B组 63 20.9±7.8 56 32
C组 31 21.5±9.6 29 17
χ2/F值 ? 1.473 2.000 0.468
P值 ? >0.05 >0.05 >0.05
表2 161例再发性胆总管结石不同术式三组患者手术相关指标的比较(±s)
组别 例数 手术时间(min) 术中出血量(ml) 排气时间(d) 住院时间(d)
A组 67 157.8±24.9 52.6±12.4 0.5±0.1 10.3±3.1
B组 63 121.6±19.5 60.8±11.7 0.4±0.1 6.8±2.2
C组 31 129.8±26.1 102.3±8.4 2.4±0.3 12.7±1.5
F值 ? 14.7753 15.6365 8.5673 6.7845
P值 ? <0.05 <0.05 <0.05 <0.05
表3 161例再发性胆总管结石不同术式三组患者术后并发症发生率的比较[例(%)]
组别 例数 胆道感染 术后胆漏 并发胰腺炎 胆道残石 总发生率
A组 67 0(0.0) 6(9.0) 0(0.0) 0(0.0) 6(9.0)
B组 63 5(7.9) 0(0.0) 7(11.1) 4(6.3) 16(25.4)
C组 31 4(12.9) 3(9.7) 2(6.5) 2(6.5) 11(35.5)
χ2值 ? ? ? ? ? 10.678
P值 ? ? ? ? ? <0.05
表4 130例再发性胆总管结石两种腹腔镜手术相关指标比较(±s)
组别 例数 结石直径(mm) 结石数目(枚) 中转开腹(例)
A组 67 13.2±4.1 6.3±2.1 5(7.5)
B组 63 9.7±2.3 3.2±1.1 4(6.3)
χ2值 ? 5.9513 10.4451 0.0625
P值 ? <0.05 <0.05 >0.05
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