腹腔镜胆总管切开取石术治疗有胆道手术史肝胆管结石的安全性分析(1)
[摘要] 目的 对有胆道手术史的肝胆管结石患者行腹腔镜胆总管切开取石术，探讨其疗效和安全性。 方法 2010年4月—2014年9月，共收治96例肝胆管结石患者，其中有胆道手术史者38例(A组)、无手术史者58例(B组)，均采用腹腔镜下胆管切开取石术予以治疗。比较两组患者的手术时间、出血量、近期并发症和远期并发症发生情况。 结果 所有患者术后随访12～60个月，两组患者临床症状、结石分布情况、取石方式等方面进行比较，差异无统计学意义(P>0.05)。两组手术时间比较差异无统计学意义(P>0.05)，A组术中出血量明显大于B组(P<0.05)。A组近期并发症发生率为52.6%、B组为8.6%，差异有统计学意义(P<0.05)；两组远期并发症比较，A组发生率为18.4%，远高于B组的1.7%。两组最终结石清除率比较，A组为97.4%，与B组的100%相近(P>0.05)。结论 对于有胆道手术史的肝胆管结石患者行腹腔镜胆总管切开取石术，是一项安全有效的微创手术方式，值得在临床推广应用。
[关键词] 肝胆管结石；腹腔镜；胆总管切开取石；肝切除
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)10(a)-0001-03
Analysis of the Safety of Laparoscopic Choledocholithotomy in the Treatment of Patients with Hepatolith and the History of Biliary Tract Operation
YIN Zhen， SUN Wei-hua
Department of General Surgery， Huaihua Second People's Hospital， Huaihua， Hunan Province， 418000 China
[Abstract] Objective To investigate the effect and safety of laparoscopic choledocholithotomy in the treatment of patients with hepatolith and the history of biliary tract operation. Methods A total of 96 cases with hepatolith admitted from April 2010 to September 2014 were divided into group A(38 cases) and group B(58 cases). Patients in group A had the history of biliary tract operation， while those in group B had not. Both groups were treated by laparoscopic choledocholithotomy. And the duration of operation， amount of bleeding， incidence of short-term and long-term complications were compared between the two groups. Results All the patients were followed up for 12～60 months after surgery. The differences in the clinical symptoms， distribution of stones， method of removing stones were not statistically significant(P>0.05). There was no statistically significant difference in duration of operation between the two groups (P>0.05). The amount of intraoperative bleeding in group A was much more than that in group B(P<0.05). The incidence of short-term complications was 52.6% in group A， and that was 8.6% in group B， the difference was statistically significant(P<0.05). The incidence of long-term complications was much higher in group A than that in group B(18.4% vs 1.7%). The final stone clearance rate of group A was similar to that of group B(97.4% vs 100%)(P>0.05). Conclusion For patients with hepatolith and the history of biliary tract operation， laparoscopic choledocholithotomy is a safe and effective minimally invasive surgery， and it is worthy of clinical application and promotion.
[Key words] Hepatolith； Laparoscope； Choledocholithotomy； Hepatectomy (银珍 孙维华)
[关键词] 肝胆管结石；腹腔镜；胆总管切开取石；肝切除
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)10(a)-0001-03
Analysis of the Safety of Laparoscopic Choledocholithotomy in the Treatment of Patients with Hepatolith and the History of Biliary Tract Operation
YIN Zhen， SUN Wei-hua
Department of General Surgery， Huaihua Second People's Hospital， Huaihua， Hunan Province， 418000 China
[Abstract] Objective To investigate the effect and safety of laparoscopic choledocholithotomy in the treatment of patients with hepatolith and the history of biliary tract operation. Methods A total of 96 cases with hepatolith admitted from April 2010 to September 2014 were divided into group A(38 cases) and group B(58 cases). Patients in group A had the history of biliary tract operation， while those in group B had not. Both groups were treated by laparoscopic choledocholithotomy. And the duration of operation， amount of bleeding， incidence of short-term and long-term complications were compared between the two groups. Results All the patients were followed up for 12～60 months after surgery. The differences in the clinical symptoms， distribution of stones， method of removing stones were not statistically significant(P>0.05). There was no statistically significant difference in duration of operation between the two groups (P>0.05). The amount of intraoperative bleeding in group A was much more than that in group B(P<0.05). The incidence of short-term complications was 52.6% in group A， and that was 8.6% in group B， the difference was statistically significant(P<0.05). The incidence of long-term complications was much higher in group A than that in group B(18.4% vs 1.7%). The final stone clearance rate of group A was similar to that of group B(97.4% vs 100%)(P>0.05). Conclusion For patients with hepatolith and the history of biliary tract operation， laparoscopic choledocholithotomy is a safe and effective minimally invasive surgery， and it is worthy of clinical application and promotion.
[Key words] Hepatolith； Laparoscope； Choledocholithotomy； Hepatectomy (银珍 孙维华)