|
Objective To compare the traditional gallbladder removal exploration of common bile duct T-tube drainage in the treatment of gallbladder and bile duct stones clinical effect EST combined with LC surgery, to explore the EST joint LC treatment of gallbladder and common bile duct stones clinical value, sum up the technical points of the surgical and the scope of application, analysis of of surgical surgery and postoperative complications occurred. Methods A retrospective analysis of cases since 2000 in Ningxia Medical University Hospital and the First People's Hospital of Yinchuan City, gallbladder and common bile duct stones elective surgery, there are clear indications for surgery, preoperative B ultrasound or MRCP examination to exclude intrahepatic bile duct, common bile duct and duodenal tumors, acute cholecystitis and cholangitis associated with serious complications, such as gangrene, perforation, acute suppurative cholangitis with shock or nervous system symptoms, suspected gallbladder malignancy, serious signs of peritonitis, cirrhosis and portal hypertension caught excluded from this study as well. Choose to comply with the above conditions line EST combined with LC surgery minimally invasive group, 300 cases with gallbladder excision under the same conditions choledochostomy T-tube drainage case-control study of 300 cases for the laparotomy group, the two groups were compared surgery blood loss, postoperative fasting time, the total number of days of hospitalization, the success rate of surgery, intraoperative and postoperative complication rate with or without a significant difference. The results of 300 cases of minimally invasive group, 273 patients EST combined with LC surgery, 20 patients with laparotomy, seven cases EST intraoperative common bile duct exploration no stones. The blood loss was 60.53 ± 20.32ml postoperative fasting time 35.79 ± 5.67h, total hospital days 6.64 ± 1.46d, after 16 cases of complications occurred in 5.3%. 300 cases in the laparotomy group, 290 cases were Chengshun, six cases of common bile duct exploration no stones the four cases diverted cholecystectomy, common bile duct jejunum Roux-en-Y anastomosis, blood loss the 90.34 ± 13.97ml, postoperative ban The food time 69.63 ± 8.46h, total hospital days 9.23 ± 1.78d, 35 patients with complications, the rate was 11.7%. Minimally invasive blood loss, postoperative fasting time, the total number of hospital days, and intraoperative and postoperative complication rate was significantly lower than the open surgery group (P lt; 0.05), two surgical success rate of surgery was no significant difference (P gt; 0.05). Conclusion For patients with gallbladder and biliary stones, EST combined with LC surgery is a real viable clinical approach, it has less trauma, quicker recovery, it is worth further promotion. Correct perioperative treatment, accurate preoperative assessment, intraoperative operated in strict accordance with the technical points, to ensure that the key to successful operation.
|