腹腔镜与开腹再次胆道手术治疗肝内外胆管结石临床对照研究.docVIP

腹腔镜与开腹再次胆道手术治疗肝内外胆管结石临床对照研究 　　[摘要] 目的 探讨腹腔镜再次胆道手术治疗肝内胆管结石的方法、手术技巧、可行性、再次胆道手术对复杂粘连情况的对策及肝内外胆管腔镜下取石的方法。方法 对2008年1月～2010年2月肝内外胆管结石腹腔镜组（n=20）与开腹组（n=20）的术后低蛋白血症的发生率、术前术后的胆红素值的改变、出血量、疼痛用药率、术后胃肠功能恢复的时间、手术时间的长短、残石率等进行数据统计分析。结果 腹腔镜组与开腹组手术时间分别为（1.94±0.31）h、（2.52±0.41）h，二者无明显差异（P＞0.05），；术后胆红素值的改变分别为（35.21±10.06）、（33.59±7.36）mmol/L， 无明显差异（P＞0.05）。术中出血量分别为（27.14±6.21）mL、（152.12±20.46）mL，术后镇痛剂使用率10%、45%，术后胃肠功能恢复时间分别为（56.28±26.04）h、（90.69±27.96）h，术后低蛋白血症发生率分别为25%、55%，术后残石率分别为5%、40%。以上项目两组数据均有统计学差异（P＜0.01）。 结论 腹腔镜再次手术治疗肝内胆管结石手术创伤小、出血少、低蛋白发生率低、恢复快、伤口感染率低、残石率低，微创意义显著，值得临床推广。 　　[关键词]腹腔镜 ； 再次手术 ； 肝内外胆管结石 　　[中图分类号] R657.4+2 [文献标识码] B [文章编号] 1673-9701（2011）23-157-02 　　 　　The Reoperation of Extra and Intrahepatic Bile Duck Stones by Laparoscopic and Open Abdomen Surgery： A Clinical Control Study 　　HUANG Guozeng1 YANG Lijie2 YANG Donghui1 WU Shouguo1 LIU Guangcheng1 CHEN Yinzeng1 　　1.Maoming Municipal Traditional Chinese Medical Hospital in Guangdong Province, Maoming 525000 ,China;2. Department of Outpatient, Beijing Shunyi District 93682 Troops, Beijing 101300,China 　　 　　[Abstract] Objective To investigate the possibility，safety and appliance of calculus of exterior and interior hepatic duct of laparoscopic biliary reoperation. Methods Forty patients with the calculus of intrahepatic duct from January. 2008 to February .2010,were devided into two groups 20 cases in each . 20 cases underwent laparoscopic sugary and another 20 cases underwent open abdominal surgery ,the operation time、 bleeding、 the time of stomach intestine functional recovery、paregoric usage after operation、postoperative 、hypoproteinmia rate、the change of bilirubin level and residual stone rate were compared between two groups. Results The operation time was（1.94±0.31）hour and（2.52±0.41）hour.The change of bilirubin level were （35.21±10.06）mmol/L and （33.59±7.36）There was no obvious different（P＞0.05）. Bleeding was （27.14±6.21）mLand（152.12±20.46）mL. the time of stomach intestine functional recovery was （556.28±26