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目的探讨经腹腔镜联合胆道镜胆管探查取石术治疗急性梗阻性化脓性胆管炎的临床疗效。方法急性梗阻性化脓性胆管炎患者113例,其中开腹行胆管探查取石术82例为开腹组,经腹腔镜联合胆道镜胆管探查取石术31例为腹腔镜组。记录2组手术时间、住院时间,观察有无胆漏、切口感染、结石残留、肝功能失代偿等,并进行2组间比较;根据手术前、后血常规及肝功能指标的变化,评估手术治疗效果。结果 2组手术均顺利,腹腔镜组无中转开腹病例,手术时间[(2.2±0.2)h]以及术后胆漏发生率(6.4%)、残石发生率(29.0%)与开腹组[(1.9±0.1)h,9.8%,25.6%]比较差异均无统计学意义(P>0.005),腹腔镜组住院时间[(5.8±0.5)d]、术后切口感染发生率(0)低于开腹组[(10.1±0.3)d,13.4%](P<0.05);术后第5天,开腹组与腹腔镜组谷丙转氨酶[(33.2±1.7)、(27.6±2.7)u/L]、谷草转氨酶[(28.9±3.6)、(34.3±10.1)u/L]、总胆红素[(17.9±0.7)、(18.8±1.2)μmol/L]以及白细胞计数[(7.4±0.2)×10~9、(7.2±0.3)×10~9/L]均较术前[(92.2±5.1)、(87.7±9.6)u/L,(78.2±4.2)、(91.2±9.6)u/L,(76.4±2.5)、(79.7±4.5)μmol/L,(15.4±2.9)×10~9/L、(16.3±3.1)×10~9/L]明显降低(P<0.05),血小板计数[(143.0±6.6)×10~9/L、(120.5±9.8)×10~9/L]较术前[(104.3±7.8)×10~9/L、(89.2±11.0)×10~9/L]增高(P<0.05),但术后以上指标组间比较差异均无统计学意义(P>0.05)。结论经腹腔镜联合胆道镜胆管探查取石术治疗急性梗阻性化脓性胆管炎效果与开腹手术相同,可缩短住院时间,降低术后切口感染发生率。
Objective To investigate the clinical efficacy of laparoscopic combined choledochoscopy in the treatment of acute obstructive suppurative cholangitis. Methods Thirty-one patients with acute obstructive suppurative cholangitis were enrolled. Among them, 82 patients underwent open cholangiopancreatography for laparotomy and 31 patients underwent laparoscopic cholecystectomy combined with laparoscopic cholangiopancreatography. The operation time, hospitalization time, the presence or absence of biliary leakage, incision infection, residual stones and decompensation of hepatic function were recorded and compared between the two groups. According to the changes of blood and liver function before and after surgery, Surgical treatment effect. Results The operation was successful in both groups. The laparoscopic group had no laparotomy, the duration of operation was (2.2 ± 0.2) h, the incidence of postoperative bile leakage (6.4%), the incidence of residual stone (29.0% There were no significant differences between the two groups (P> 0.005), the length of hospital stay in laparoscopic group (5.8 ± 0.5) d and the incidence of incision infection (0) (P <0.05). On the fifth day after operation, the alanine aminotransferase ([(33.2 ± 1.7), (27.6 ± 2.7) (17.9 ± 0.7), (18.8 ± 1.2) μmol / L] and leukocyte counts [(7.4 ± 3.6), (34.3 ± 10.1) u / (92.2 ± 5.1), (87.7 ± 9.6) u / L, (78.2 ± 4.2), (91.2 ± 9.6) and (± 0.2) × 10 ~ 9 and (7.2 ± 0.3) × 10 ~ ) (P <0.05), and the difference was statistically significant (P <0.05) ), Platelet count (143.0 ± 6.6) × 10 ~ 9 / L and (120.5 ± 9.8) × 10 ~ 9 / L were significantly higher than those of preoperative [(104.3 ± 7.8) × 10 ~ 9 / L and (89.2 ± 11.0) × 10 ~ 9 / L] (P <0.05), but there was no significant difference between the above indexes after operation (P> 0.05). Conclusion Laparoscopic cholangiopancreatography is the same as laparotomy in the treatment of acute obstructive suppurative cholangitis, which can shorten the length of hospital stay and reduce the incidence of postoperative incision infection.