本文選題：腹腔鏡　切入點(diǎn)：先天性膽管擴(kuò)張癥　出處：《南昌大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：先天性膽管擴(kuò)張癥(Congenital Biliary Dilatation,CBD)一經(jīng)明確診斷應(yīng)盡早手術(shù)治療,以防誘發(fā)膽管炎、胰腺炎、肝內(nèi)肝外膽管結(jié)石、膽汁性肝硬化、囊腫破裂甚至惡變。目前公認(rèn)的治療先天性膽管擴(kuò)張癥(CBD)的標(biāo)準(zhǔn)術(shù)式是囊腫切除+膽管空腸Roux-en-Y吻合術(shù)。1995年國外學(xué)者報道在腹腔鏡輔助下完成囊腫切除+膽管空腸Roux-en-Y吻合術(shù)治療兒童先天性膽管擴(kuò)張癥取得了良好的效果。成年患者病程較長,腹腔鏡手術(shù)操作難度大,完全腹腔鏡下手術(shù)對術(shù)者技術(shù)要求高,開展較晚。目的:對比分析南昌大學(xué)第二附屬醫(yī)院完全腹腔鏡手術(shù)和傳統(tǒng)開腹手術(shù)兩種不同手術(shù)方式下患者術(shù)中及術(shù)后情況的差異,探討完全腹腔鏡下治療成人I型先天性膽管擴(kuò)張癥的安全性及可行性。方法:回顧南昌大學(xué)第二附屬醫(yī)院肝膽外科2010年3月~2014年10月間手術(shù)治療的53例成人I型先天性膽管擴(kuò)張癥患者的病例資料。按手術(shù)方式分為完全腹腔鏡手術(shù)組(A組)和傳統(tǒng)開腹手術(shù)組(B組),其中A組22例,B組31例。比較兩組病例的手術(shù)時間、術(shù)中出血量、術(shù)后排氣時間、術(shù)后住院時間、術(shù)后并發(fā)癥、術(shù)后肝功能指標(biāo)及術(shù)后鎮(zhèn)痛情況。采用卡方檢驗分析患者術(shù)前一般資料、術(shù)后并發(fā)癥和術(shù)后鎮(zhèn)痛情況;采用兩樣本比較t檢驗分析兩組病例的手術(shù)時間、術(shù)中出血量、術(shù)后排氣時間、術(shù)后住院時間和術(shù)后肝功能指標(biāo),使用SPSS 22.0統(tǒng)計軟件進(jìn)行計算,以α=0.05為檢驗水準(zhǔn)。結(jié)果:1、一般情況:兩組病例在年齡分布、性別比例、囊腫直徑各項指標(biāo)之間的差異均無統(tǒng)計學(xué)意義;2、術(shù)中情況:完全腹腔鏡手術(shù)組手術(shù)時間長于傳統(tǒng)開腹手術(shù)組,但術(shù)中出血量少于傳統(tǒng)開腹手術(shù)組(P0.01);3、術(shù)后情況:完全腹腔鏡手術(shù)組患者術(shù)后排氣時間早于傳統(tǒng)開腹手術(shù)組,住院時間短于傳統(tǒng)開腹手術(shù)組(P0.05);完全腹腔鏡組手術(shù)對肝功能損傷程度小于傳統(tǒng)開腹手術(shù)組(P0.05);術(shù)后鎮(zhèn)痛患者少于傳統(tǒng)開腹手術(shù)組;(P0.05);在術(shù)后并發(fā)癥方面的比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、完全腹腔鏡下治療成人I型先天性膽管擴(kuò)張癥是安全、可行的;2、完全腹腔鏡下治療成人I型先天性膽管擴(kuò)張癥手術(shù)時間長于傳統(tǒng)開腹手術(shù),但其對肝功能損傷小、疼痛輕,術(shù)后恢復(fù)優(yōu)于傳統(tǒng)開腹手術(shù)。
[Abstract]:Once the diagnosis of congenital cholangiectasis is confirmed, surgical treatment should be done as soon as possible to prevent the development of cholangitis, pancreatitis, extrahepatic cholelithiasis and biliary cirrhosis. Cyst rupture or even malignant change. The standard procedure for the treatment of congenital cholangiectasis is cystectomy and jejunojejunostomy (Roux-en-Y). In 1995, foreign scholars reported that cystectomy was performed under laparoscopically assisted cholangiojejunostomy. Roux-en-Y anastomosis has achieved good results in the treatment of congenital cholangiectasis in children. The operation of laparoscopic surgery is very difficult. Objective: to compare and analyze the difference of the operative and postoperative conditions between the complete laparoscopic surgery and the traditional open surgery in the second affiliated Hospital of Nanchang University. To investigate the safety and feasibility of complete laparoscopy in the treatment of adult type I congenital cholangiectasis methods: a retrospective review of 53 cases of adult type I treated by hepatobiliary surgery from March 2010 to October 2014 in the second affiliated Hospital of Nanchang University. The data of patients with congenital cholangiectasis were divided into two groups: complete laparoscopic operation group (group A) and traditional open operation group (group B: 31 cases, group A: 22 cases, group B, n = 31). The operative time was compared between the two groups. Blood loss, postoperative exhaust time, postoperative hospital stay, postoperative complications, postoperative liver function and postoperative analgesia were analyzed by chi-square test. The operation time, intraoperative bleeding volume, postoperative exhaust time, postoperative hospitalization time and postoperative liver function index of the two groups were analyzed by t-test. The results were calculated by SPSS 22.0 software. Results: 1, general situation: two groups of cases in age distribution, sex ratio, There was no significant difference in the diameter of cysts between the two groups. The operative time of complete laparoscopic surgery group was longer than that of traditional laparotomy group. However, the amount of intraoperative bleeding was less than that of the traditional laparotomy group (P 0.01). After operation, the postoperative exhaust time of the patients in the complete laparoscopic operation group was earlier than that in the traditional open operation group. The duration of hospitalization was shorter than that of the traditional laparotomy group (P 0.05), the degree of liver function injury in the complete laparoscopy group was less than that in the traditional open operation group (P 0.05), the postoperative analgesia was less than that in the traditional open operation group (P 0.05), and there was no difference in postoperative complications. Conclusion: it is safe to treat adult type I congenital cholangiectasis with complete laparoscopy. The operative time of complete laparoscopy in the treatment of adult type I congenital cholangiectasis is longer than that of traditional open surgery, but it has less damage to liver function and less pain, and the postoperative recovery is better than that of traditional open surgery.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R657.44

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