不同方式腹腔镜胆道探查术治疗肝外胆管结石的临床研究  

Different methods of laparoscopic common bile duct exploration for extrahepatic bile duct stones

作　　者：汤晓东[1] 刘双海[1] 蒋剑[1] 周一夫[1] 陈胜[1] 赵振国[1] 

机构地区：[1]东南大学医学院附属江阴医院肝胆外科,214400

出　　处：《中华肝胆外科杂志》2013年第8期589-592,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析比较三种不同方式腹腔镜胆道探查术治疗肝外胆管结石的疗效及其临床应用价值。方法回顾性分析了2010年1月至2012年12月由同一术者实施的120例腹腔镜胆道探查术患者的临床资料。结果行腹腔镜胆囊切除＋经胆囊管胆道探查（A组）15例，腹腔镜胆囊切除＋胆总管切开探查＋胆管一期缝合（B组）85例，腹腔镜胆囊切除＋胆总管切开探查＋T管引流（C组）20例，全组均顺利完成手术。与C组比较，A组及B组所需手术时间、住院费用、术后住院时间、腹腔引流时间、恢复正常生活时间较少，差异有统计学意义（P〈0．05）；A组与B组比较除腹腔引流时间较短外（P〈0．05），其余指标差异无统计学意义（P〉0．05）。三组术后并发症及远期结果无明显区别。结论三种不同方式的微创手术都有各自的适应证。对适宜患者，腹腔镜下经胆囊管胆道探查术治疗肝外胆管结石患者的疗效优于腹腔镜下胆总管切开探查术，而腹腔镜下胆总管切开探查＋一期缝合的疗效则优于腹腔镜下胆总管切开探查＋T管引流。Objective To compare the efficacy and safety of three different methods of laparoscopic common bile duct exploration （LCBDE）. Methods The clinical data of patients with LCBDE treated in our hospital by the same surgeon from January 2010 to December 2012 were retrospectively analyzed. These patients were divided into three groups according to the 3 surgical methods： Group A： 15 patients were treated with laparoscopic transcystic common bile duct exploration （LTCBDE）. Group B： 85 patients were treated with laparoscopic common bile duct exploration followed by primary duct closure （LCBDEPDC）. Group C： 20 patients were treated with laparoscopic common bile duct exploration and T tube drainage （LCBDE-TD）. The study measured the TBIL, inner diameter of common bile duct, costs, length of operation, postoperative hospital stay, peritoneal drainage time, and operation-related complications. Results The operations were successfully carried out in the 3 groups of patients. When compared with group C, group A and group B had significantly shorter operative time, shorter postoperative hospital stay, shorter peritoneal drainage time, lower hospital costs, and earlier return to work （P〈0.05）. The only significant difference between group A and group B was the peritoneal drainage time. There was no significant difference in the incidences of postoperative complications between the 3 groups （P〉0.05）. Conclusions The three different methods of LCBDE had their own indications. LTCBDE was better than primary suture, and LCBDEPDC was better than T-tube drainage after laparoscopic common bile duct exploration.

关 键 词：胆结石 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]