胆囊结石继发胆总管结石微创治疗的回顾性研究.docVIP

精品论文 参考文献 胆囊结石继发胆总管结石微创治疗的回顾性研究 作者单位：苏州大学附属第一医院普外科，江苏 苏州 215006 　　DOI：10.7504/nk2016010203 中图分类号：R587.1 文献标识码：A 　　摘要：目的 通过比较分析腹腔镜下经胆总管切开一期缝合、腹腔镜下经胆总管切开T管引流以及经内镜逆行性胰胆管造影术（ERCP）+腹腔镜下胆囊切除术（LC）治疗胆囊结石继发胆总管结石病人的疗效，以评价各种不同治疗方式治疗胆总管结石的临床价值。方法：自2007年12 月——2015年6月，根据7项筛选标准对符合条件的155例病人按治疗方式不同分为经胆总管切开途径插入胆道镜探查取石组（n=98）和ERCP+LC组（n=57），前者又分为胆总管一期缝合组（n=62）和T管引流组（n=36）。比较观察3组病例的各项数据。结果：胆总管一期缝合组手术时间（操作时间）明显短于T管引流组和ERCP+LC组（Plt;0.05），T管引流组腹腔引流时间、恢复正常工作时间、术后平均输液量明显长于或高于胆总管一期缝合组和ERCP+LC组（Plt;0.05）；而ERCP+LC组住院费用明显高于胆总管一期缝合组和T管引流组（Plt;0.05）。结论：虽然腹腔镜下经胆总管切开一期缝合治疗胆囊结石继发胆总管结石的疗效优于腹腔镜下经胆总管切开T管引流和ERCP+LC术,但是三种手术都各有其优势和适应人群。 　　关键词：腹腔镜下经胆总管切开一期缝合；腹腔镜下经胆总管切开T管引流；经内镜逆行性胰胆管造影术+腹腔镜下胆囊切除术；治疗 　　A retrospective prospective study on minimally invasive treatment for common bile duct stone 　　Wang Gang，Zhou Xiaojun，Mao Zhongqi 　　（Department of General Surgery,The First Affiliated Hospital of Soochow University, Soochow 215006） 　　Abstract: 　　[Objective] To evaluate the effects of primary common bile duct closure and T-tube drainage after laparoscopy choledochotomy and Endoscopic Retrograde Cholangiopancreatography(ERCP) for common bile duct stones. 　　[Methods] The enrollment of the patients was in accordance with 4 criteria. Appropriate 155 patients with cholecystolithiasis and secondary common bile duct stones from December 2007 to June 2015 were divided into three groups: Primary common bile duct closure group (n=62) and T-tube drainage group (n=36) and ERCP group (n=57). Their all data were recorded and studied prospectively,and patients were followed up after discharge. 　　[Results] Primary common bile duct closure group had the least operation time in three groups. T-tube drainage group had the most quantity of postoperative transfusion and the most average transfusion quantities (Plt;0.05). 　　[Conclsion] Primary common bile duct closure have the advantage of T-tube drainage and ERCP, there were no significant difference between T-tube drainage group and ERCP. 　　Key words: primary common bil