切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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
[1]
刘远滨，黄梁，韩意，等．两种内镜下术式治疗胆总管结石的临床效果与安全性比较[J/CD]．中华普外科手术学杂志(电子版)，2018，12(4)：315-318.
[2]
Ishiwatari H, Kawakami H, Hisai H, et al. Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial[J]. Endoscopy, 2016, 48(4)：350-357.
[3]
曾华平，刘凤祝，刘擎．老年胆总管结石与中青年患者经腹腔镜胆总管探查取石并一期缝合治疗的比较研究[J/CD]．中华普外科手术学杂志(电子版)，2018，12(4)：319-322.
[4]
邹正东，黄学伟．腹腔镜胆总管结石取石术联合免T管一期缝合术的疗效分析[J/CD]．中华普外科手术学杂志(电子版)，2018，12(4)：323-325.
[5]
Kato S, Zakimi M, Yamada K, et al. Tu1595 A Cohort Study of the Predictive Factors for Bile Duct Stone Recurrence After Endoscopic Lithotripsy for Na？VE Major Duodenal Papilla[J]. Gastrointestinal Endoscopy, 2016, 83(5)：AB620-AB620.
[6]
梁志坚，方永平，李坤平，等．十二指肠乳头切开联合腹腔镜胆囊切除术治疗老年性胆囊并胆总管结石[J]．中华肝胆外科杂志，2017, 23(8)：521-525.
[7]
Tavernaraki A, Fragaki M, Vardas E, et al. Tu1590 Endoscopic Plastic Stenting for Common Bile Duct Stones in the Elderly: Stent Changing Every 12 Months. a Historical Cohort Study[J]. Gastrointestinal Endoscopy, 2016, 83(5)：AB618-AB618.
[8]
Jeong S, Lee DH, Yong WS.Tu1598 Needle Knife Fistulotomy As a Primary Biliary Cannulation Procedure in Common Bile Duct Stone Patients With High Risk for Post－Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Prospective Feasibility Study[J]．Gastrointestinal Endoscopy，2016，83(5)：AB620-AB621.
[9]
姚利，陈先祥，涂华华，等．内镜逆行性胰胆管造影术与腹腔镜胆总管探查术治疗胆囊切除术后胆总管结石的疗效比较[J]．临床外科杂志，2018，26(2)：121-123.
[10]
Elmunzer BJ, Feussner D, Payne KM, et al.860 Combined Endoscopic－Percutaneous Biliary Restoration After Severe Bile Duct Injury During Cholecystectomy[J]. Gastrointestinal Endoscopy, 2017, 85(5)：AB112-AB112.
[11]
Tang RS, Lam SF, Chan PY, et al. Tu1603 Predicting Factors of Delayed Versus Early Definitive ERCP for Stone Clearance in Patients With Common Bile Duct Stone and Acute Cholangitis Managed With Temporary Biliary Stenting[J]. Gastrointestinal Endoscopy, 2016, 83(5)：AB622-AB622.
[12]
马珺，瞿建国．微创内镜联合术式与传统开放术式治疗胆囊并胆总管结石疗效及安全性比较[J]．中国现代医学杂志，2016, 26(8)：91-94.
[13]
Trindade AJ, Hirten R, Sejpal DV. Use of digital cholangioscopy in a dilated bile duct for detection of small symptomatic bile duct stones[J]．Gastrointestinal Endoscopy, 2016, 84(2)：372-372.
[14]
石玉琪，许春芳．ERCP联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石术后胆总管结石复发的危险因素分析[J]．中华消化内镜杂志，2016, 33(10)：689-692.
[15]
Tsutsumi K, Kato H, Yabe S, et al.Tu1593 Treatment of Bile Duct Stones in Patients With Prior Hepaticojejunostomy: A Percutaneous Approach Using Cholangioscopy vs. an Endoscopic Approach Using Short Double－Balloon Enteroscopy[J]．Gastrointestinal Endoscopy，2016，83(5)：AB619-AB619.
[16]
李俊．腹腔镜胆总管探查术与内镜下十二指肠乳头括约肌切开术治疗胆总管结石的疗效对比[J]．河北医学，2017, 23(6)：937-941.
[17]
李凤鸣．十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石[J]．腹腔镜外科杂志，2016，21(7)：540-542.
[18]
Lesur G．French comment on article: Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial[J]．Endoscopy, 2016, 48(4)：413-414.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[10] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[11] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[12] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[13] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
[14] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[15] 叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号