摘要
目的比较腹腔镜保胆取石(息肉)术(LCPE)与腹腔镜胆囊切除术(LC)治疗胆囊结石(息肉)的疗效。方法回顾性分析空军总医院2009年1月至2012年6月经LCPE治疗胆囊结石及息肉的患者118例(LCPE组)和同期年龄相仿、病种相同的经LC治疗胆囊结石及息肉的患者118例(LC组)的临床资料,术后随访3～45个月,比较二者手术时间、术中出血量、排气时间、手术并发症、住院天数、住院费用、术后并发症等手术情况和近远期生活质量。LCPE组选择部分患者测定保胆手术前及手术后3个月的胆囊收缩率,并作比较。结果 LCPE组中118例手术均获成功,结石和息肉均取干净,术中顺利,无副损伤,术后无出血、胆漏、急性胆囊炎、胰腺炎、继发性胆总管结石及切口感染等并发症发生,患者当日均可下床,次日进流食或半流食,2～7 d可出院。术后随访3～45个月,患者无消化不良、腹胀及腹泻发生,无胆囊癌发生。3例患者分别于术后3、12、18个月胆囊内复发少量泥沙样结石,给予利胆排石药物治疗1个月后复查腹部超声显示胆囊泥沙样结石消失。1例术后1 a超声检查显示有1枚0.3 cm的胆囊息肉再生,经间断服用利胆药物3个月后复查未见息肉增大。LC组118例中完成手术115例,另3例分别由于损伤肝总管、胆囊动脉、十二指肠而开腹手术。115例LC组患者术后亦随访3～45个月,9例出现消化不良,5例仍有间断上腹或右上腹胀痛不适,7例大便次数增多及间断腹泻。LCPE组手术时间较LC组明显延长(P<0.05),但术中出血量、排气时间及术后腹泻发生率均明显少于LC组(P<0.05)。LCPE组单纯胆囊结石患者和结石合并息肉患者术后3个月胆囊收缩率较术前明显增加,差异有统计学意义(P<0.05),单纯胆囊息肉患者术后3个月胆囊收缩率和术前比较,差异无统计学意义(P>0.05)。结论选择合适的患者、掌握好手术适应证、直视下取净结石和息肉及可靠的胆囊底部切口缝合是确保LCPE成功的关键;LCPE较LC操作简便,手术安全性高,术中出血量较少,术后消化不良、腹胀、腹泻发生等方面优于LC,生活质量优于LC患者;LCPE患者术后结石复发及息肉再生较少。
Objective To compare the therapeutic effect of laparoscopic cholelithotomy together with cholecystic polypectomy（LCPE）and laparoscopic cholecystectomy（LC）.Methods The clinical data of 118 cases who had LCPE（LCPE group）and 118 cases who had LC（LC group）with identical sex,age,entity between Jan.2009 and Jun.2012 in General Hospital of Airforce was analyzed retrospectively.Subsequently all the patients were performed from 3 to 45 months after operation,and their operation time,bleeding volume during operation,the passage of gas by anus time,operation complications,the days in hospital,cost of hospitalization,postoperative complications,short-and long-term quality of life were compared.Some patients in LCPE group were chosen to detect and compare the gallbladder contraction rate before operation and 3 months after operation.Results LCPE had been performed successfully on all 118 cases.In the 118 cases of LCPE group,stones and polyps were taken out clearly;no bleeding,biliary fistula,acute cholecystitis or pancreatitis,secondary common bile duct stones,wound infections and other complications happened after the operation.All the patients could get out of bed at the same day,could eat liquid-or half-liquid-food on the second day and could leave hospital in two to seven days.During the 3-45 months of follow-up in LCPE group,no dyspepsia,abdominal distension,diarrhea and carcinoma of gallbladder occurred.Three cases in LCPE group had muddy stone recurrence in 3,12 and 18 postoperative months respectively,and then their stones disappeared after taking choleretic and removing calculus drugs for one month;another patient in LCPE group took abdominal ultrasonic examination one year later after operation and found a 3 mm-diameter gallbladder polyp regeneration,and subsequently choleretic drugs therapy was taken for 3 months,and then recheck abdominal ultrasound showing the polyp un-enlarged.In the 118 cases of LC group,115 cases performed operation successfully,the other 3 cases were converted to laparotomy during LC due to injury of common hepatic duct,cholecystic artery and duodenum,respectively.During postoperative follow-up period from 3 to 45 months in LC group,9 cases appeared dyspepsia,5 cases still felt interrupted distending pain in superior belly or on the right upper quadrant,7 cases had increasing stool frequency or interrupted diarrhea.The operation time of LCPE group was longer significantly than that in LC group（P〈0.05）while the bleeding volume during operation,the passage of gas by anus time and postoperative diarrhea rate in LCPE group were fewer significantly than those in LC group.The gallbladder contraction rate of simple cholecystolithiasis and stone together with polyps patients in LCPE group 3 months after operation increased significantly than that before operation（P〈0.05）,while in simple gallbladder polyps patients there was no significant difference（P〈0.05）.Conclusion To choose the suitable case,prehension operation indication,take calculi and polyps clearly out of gallbladder under euthyphoria,and to reliably suture the incision of the gallbladder are the key points to guarantee LCPE successfully.Compared with LC,LCPE has easier and safer manipulation,lesser hemorrhage volume,fewer complications such as dyspepsia,abdominal distension and diarrhea,and a better life quality.Patients who had LCPE have seldom calculi reformation and polyps regeneration.
出处
《新乡医学院学报》
CAS
2013年第4期286-289,共4页
Journal of Xinxiang Medical University
