腹腔镜联合胆道镜微创保胆取石术与腹腔镜胆囊切除术的疗效对比分析-普通外科学专业论文.docxVIP

汕头大学医学院七年制硕士毕业论文 汕头大学医学院七年制硕士毕业论文 I I 摘要 目的 比较腹腔镜联合胆道镜微创保胆取石术与腹腔镜胆囊切除术（ laparoscopic cholecystectomy,LC）治疗胆囊结石的疗效，探讨腹腔镜联合胆道镜微创保胆取石术在临床 应用的意义及可行性。 方法 将 2010 年 10 月 01 日至 2012 年 02 月 07 日入住我院肝胆外科的 28 例诊断为胆囊结 石并行腹腔镜联合胆道镜微创保胆取石术的患者与同期的 54 例诊断为胆囊结石行腹腔镜 胆囊切除术的患者进行比较分析。对两组病例的手术时间、出血量、术后住院时间、并发 症、住院费用等对比指标进行统计分析。术后两组患者行 1-15 月的随访。 结果 微创保胆取石组有 25 例完成保胆取石术，手术成功率 89.2%，2 例因结石嵌顿于胆囊 颈无法取出，1 例因附壁结石无法取出均改行腹腔镜胆囊切除术，术后均恢复良好，无严 重并发症发生；术后随访复查 B 超未见胆囊或胆总管残留结石。对比组患者均行腹腔镜胆 囊切除术。微创保胆取石术组与腹腔镜胆囊切除术组比较，术中出血少，术后腹痛、腹泻 发生率低，但手术时间较长，切口感染率、住院费用较高，术后排气时间、术后住院天数、 胆管损伤率无统计学意义（P0.05）。 结论 采取腹腔镜联合胆道镜微创保胆取石术治疗胆囊结石，需严格把握手术适应症，排除 禁忌症，其具有手术出血少，术后腹痛腹泻发生率低，结石复发率低，提高患者生活质量 等优势。腹腔镜联合胆道镜微创保胆取石术不增加胆管损伤发生率，不延长术后住院时间， 具有良好疗效，可以在临床应用。 关键词：胆囊结石；微创手术；保胆手术；腹腔镜胆囊切除术；腹腔镜；胆道镜 II II Abstract [Objective] To compare the efficacy between laparoscope and cholangioscopy for preservation of gallbladder and HYPERLINK /laparoscopic laparoscopic cholecystectomy (LC ) for HYPERLINK /cholecystolithiasis cholecystolithiasis, and to investigate the significance and feasibility of laparoscope cholangioscopy for preservation of gallbladder. [Method] Retrospective analysis of the 28 cases cholecystolithiasis that treated by laparoscope and cholangioscopy for preservation of gallbladder, compare the clinical data with the 54 cases treated by LC during the same period .Compare the data of operation time,bleeding volume during the operation,the hospitalization after operation, complications, expenditure and so on.Both the follow-up investigation time are 1 to 15 months. [Results] Laparoscope and cholangioscopy for preservation of gallbladder group have been operated successfully in 25 cases, HYPERLINK /success success HYPERLINK /ratio rate is 89.2%,2 cases because the stone in the HYPERLINK /neck neck HYPERLINK /of of HYPERLINK /gallbladder gallbladder and 1 cases in the HYPERLINK /Gallbladder gallbladder HYPERLINK /wall wall could not be removed,were converted to LC.All the patients were recovered well,n