發(fā)布時(shí)間：2018-01-20 09:56

  本文關(guān)鍵詞： 膽囊結(jié)石 膽總管結(jié)石 T管引流術(shù) 一期縫合術(shù) 三鏡聯(lián)合一期縫合術(shù)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究通過觀察肝下引流時(shí)間、術(shù)后住院時(shí)間、手術(shù)費(fèi)用、膽漏、急性胰腺炎及殘留結(jié)石等多項(xiàng)指標(biāo),對(duì)比分析三種治療膽囊結(jié)石合并膽總管結(jié)石的微創(chuàng)方式——腹腔鏡下膽囊切除膽總管探查T管引流術(shù),腹腔鏡下膽囊切除膽總管探查一期縫合術(shù)和腹腔鏡-膽道鏡聯(lián)合十二指腸鏡一期縫合術(shù)的臨床療效。探討以上三種微創(chuàng)術(shù)式在治療膽囊結(jié)石合并膽總管上的臨床治療效果及各自優(yōu)缺點(diǎn),以期為臨床醫(yī)生治療膽囊結(jié)石合并膽總管結(jié)石最適手術(shù)方式的選擇提供參考和依據(jù)。方法:收集大連醫(yī)科大學(xué)附屬第一醫(yī)院普通外科2014年1月至2016年12月診治的153例膽囊結(jié)石合并膽總管結(jié)石患者的病例資料。根據(jù)入院后手術(shù)方式分為三組:腹腔鏡下膽囊切除膽總管探查T管引流術(shù)(A組)108例,腹腔鏡下膽囊切除膽總管探查一期縫合術(shù)(B組)31例,腹腔鏡-膽道鏡聯(lián)合十二指腸鏡一期縫合術(shù)(C組)13例。A組患者行腹腔鏡下膽囊切除術(shù)(laparoscopic cholecystomy,LC)+腹腔鏡膽總管探查術(shù)(laparoscopic common bile duct exploration,LCBDE)+T管引流術(shù)(T-tube drainage,TD);B組患者行LC+LCBDE+一期縫合術(shù)(primary suture,PS);C組患者先行LC+LCBDE切除膽囊并取凈膽總管結(jié)石,隨后行經(jīng)內(nèi)鏡鼻膽管引流術(shù)(endoscopic nasobibiary,ENBD)+PS。通過對(duì)比分析三組病例的一般臨床資料,包括性別、年齡、膽總管內(nèi)徑、結(jié)石數(shù)目、結(jié)石最大直徑和術(shù)前肝功能,檢驗(yàn)各組之間是否具有可比性。然后,分析三種手術(shù)方式在肝下引流管放置時(shí)間、術(shù)后住院時(shí)間、手術(shù)費(fèi)用、術(shù)后膽漏、胰腺炎及殘留結(jié)石等并發(fā)癥方面的差異。結(jié)果:1.一般臨床資料:經(jīng)統(tǒng)計(jì)分析三組病例在性別、年齡、膽總管直徑、結(jié)石數(shù)目、結(jié)石最大直徑和術(shù)前肝功能方面的差異不具有顯著性(P(29)0.05),表明從一般臨床資料來看,各組之間具有可比性。2.術(shù)后情況:B組和C組的術(shù)后肝下引流時(shí)間及術(shù)后住院時(shí)間均明顯短于A組(P(27)0.05)。然而,B組與C組在術(shù)后肝下引流時(shí)間和術(shù)后住院時(shí)間相比無明顯區(qū)別(P(29)0.05)。3.術(shù)后并發(fā)癥:三組病例在術(shù)后膽漏、急性胰腺炎、結(jié)石殘留和總并發(fā)癥發(fā)生率方面相比較,結(jié)果顯示各組之間的差異均無統(tǒng)計(jì)學(xué)意義(P(29)0.05)。4.手術(shù)費(fèi)用:C組的手術(shù)費(fèi)用明顯高于A、B兩組,且差異具有顯著性(P(27)0.05);A組和B組患者在手術(shù)費(fèi)用上的差異同樣具有顯著性,B組的費(fèi)用明顯低于A組(P(27)0.05)。結(jié)論:在本研究納入的臨床病例中,通過對(duì)上述三種不同微創(chuàng)術(shù)式相比,腹腔鏡-膽道鏡聯(lián)合十二指腸鏡一期縫合術(shù)這一新的微創(chuàng)術(shù)式治療膽囊結(jié)石合并膽總管結(jié)石的臨床療效明顯,是安全、可行的,縮短了術(shù)后引流時(shí)間、住院時(shí)間,且并未增加膽漏和結(jié)石殘留。在具備各項(xiàng)硬件及軟件的前提下,嚴(yán)格掌握手術(shù)適應(yīng)癥和操作技巧的情況下,三鏡聯(lián)合一期縫合術(shù)可作為治療膽囊結(jié)石合并膽總管結(jié)石的首選術(shù)式,值得臨床廣泛推廣。
[Abstract]:Objective: This study through the observation of hepatic drainage time, postoperative hospitalization time, cost of surgery, bile leakage, acute pancreatitis and residual calculus index, comparative analysis of three kinds of treatment of cholecystolithiasis and choledocholithiasis: minimally invasive laparoscopic cholecystectomy and common bile duct exploration and T tube drainage, the clinical curative effect of laparoscopic cholecystectomy choledochotomy and laparoscopic suture - choledochoscope duodenoscope suture. To investigate the clinical effect of more than three kinds of minimally invasive surgery in the treatment of cholecystolithiasis with common bile duct and the respective advantages and disadvantages, the optimal choice of surgical approach and provide a reference basis for clinical treatment of gallbladder and bile choledocholithiasis. Methods: general surgery from January 2014 to December 2016 the First Affiliated Hospital of Dalian Medical University collected 153 cases of cholecystolithiasis and choledocholithiasis patients The case data. According to the operation were divided into three groups: laparoscopic cholecystectomy and common bile duct exploration and T tube drainage (A group) 108 cases, laparoscopic exploration of common bile duct suture (group B) 31 cases, laparoscopic - choledochoscope and duodenoscope (a suture C group) 13 cases of.A patients who underwent laparoscopic cholecystectomy (laparoscopic cholecystomy, LC) + laparoscopic common bile duct exploration (laparoscopic common bile duct exploration, LCBDE) +T tube drainage (T-tube drainage, TD); group B underwent LC+LCBDE+ stage suture (primary suture, PS C); the LC+LCBDE group patients were given cholecystectomy and common bile duct stones were removed, then underwent endoscopic nasobiliary drainage (endoscopic nasobibiary, ENBD +PS.) through the comparative analysis of the clinical data of three cases including gender, age, diameter of common bile duct stones, the number and the diameter of the largest stone 鏈�鍓嶈倽鍔熻�，

本文編號(hào)：1447758