摘要
目的探讨三镜(腹腔镜、十二指肠镜、胆道镜)联合治疗胆道结石的方法、时机和临床疗效。方法自2004年1月至2011年12月应用腹腔镜、十二指肠镜和胆道镜联合治疗肝外胆管结石339例、胆管结石合并胆囊结石649例共988例作为三镜组。取同期在行常规开放手术的类似患者668例作为对照组。采用SPSS 13.0软件进行数据处理,两组手术时间、术中出血、术后肛门排气时间、住院时间比较采用t检验;术后止痛药物应用、术后并发症、术后死亡率组间比较采用χ2检验,以P<0.05为差异有统计学意义。结果三镜组988例:行LCDE+术中胆道镜339例;行LC+LCDE+术中胆道镜552例;行LC+LCDE+术中胆道镜+"T"型管引流97例;三镜组与常规组比较在术中出血(P=0.001)、术后肛门排气时间(P=0.023)、住院时间(P=0.001)、术后止痛药物应用(P=0.031)、术后切口感染并发症(P=0.001)相比均有统计学意义(P<0.05);手术时间(P=0.463)与术后死亡(P=0.301)、术后胆漏(P=0.283)差异无统计学意义。结论三镜联合治疗胆道结石是一种值得临床广泛推广的治疗方法。
Objective To investigate the application of ＂three endoscopes combination,TEC＂（ duodenoscope,laparoscope and choledochoscope） in treating biliary calculi,including operative skills,indications and clinical outcome. Methods From January 2004 to December 2011,339 patients with extrahepatic bile duct stones and 649 patients with extrahepatic bile duct stone and gallbladder stones were treated with TEC treatment in our hospital. In contrast,conventional open surgery was performed for 668 patients serving as a control group. Data processing was carried out using SPSS13. 0 software. Operative time,intraoperative blood loss,exhausting time and hospital stay were compared using Student＇s t test,but postoperative use of analgesic drugs,the incidence of complications and perioperative death were compared using the Chi-square test. P 0. 05 was considered statistically significant. Results In the 988 patients in the TEC group LCDE ＋ intraoperative choledochoscopy was performed in 339 patients,LC ＋ LCDE ＋intraoperative choledochoscopy in 552,and LC ＋ LCDE ＋ intraoperative choledochoscopy ＋ ＂ T tube＂ drainage in 97. There were significant differences between the 2 groups（ P 0. 05） in blood loss（ P =0. 001）,exhausting time（ P = 0. 023）,hospital stay（ P = 0. 001）,application of analgesic（ P = 0. 031） and incisional infection（ P = 0. 001）. There were no significant differences between the 2 groups（ P〉0. 05） in operation time（ P = 0. 463）,postoperative death（ P = 0. 301） and postoperative biliary leakage（ P = 0. 283）.Conclusion TEC is promising in treating biliary calculi.
出处
《中华普外科手术学杂志（电子版）》
2015年第1期29-31,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
武警部队科学技术进步奖(2012-3-37-1)
Supported by Grants from the progress prize in scientific and collective technology of Armed Police Forces
No.2012-3-37-1
