胆囊结石继发胆总管结石微创治疗的回顾性研究  

A Retrospective Study on Minimally Invasive Treatment for Common Bile Duct Stone

作　　者：王钢[1] 周晓俊[1] 毛忠琦[1] 

机构地区：[1]苏州大学附属第一医院普外科,江苏 苏州215006

出　　处：《中国血液流变学杂志》2016年第4期440-443,共4页Chinese Journal of Hemorheology

摘　　要：目的 通过比较分析腹腔镜下经胆总管切开一期缝合、腹腔镜下经胆总管切开T管引流以及经内镜逆行性胰胆管造影术（ERCP）＋腹腔镜下胆囊切除术（LC）治疗胆囊结石继发胆总管结石病人的疗效,以评价各种不同治疗方式治疗胆总管结石的临床价值.方法 2007年12月—2015年6月,根据7项筛选标准对符合条件的155例病人按治疗方式不同分为胆总管一期缝合组（n=62）、T管引流组（n=36）和ERCP＋LC组（n=57）.比较观察3组病例的各项数据.结果 胆总管一期缝合组手术时间明显短于T管引流组和ERCP＋LC组（P〈0.05）,T管引流组腹腔引流时间、恢复正常工作时间、术后平均输液量明显长于或高于胆总管一期缝合组和ERCP＋LC组（P〈0.05）;而ERCP＋LC组住院费用明显高于胆总管一期缝合组和T管引流组（P〈0.05）.结论 虽然腹腔镜下经胆总管切开一期缝合治疗胆囊结石继发胆总管结石的疗效优于腹腔镜下经胆总管切开T管引流和ERCP＋LC术,但是三种手术都各有其优势和适应人群.Objective To evaluate the effects of primary common bile duct closure and T-tube drainage after laparoscopy choledochotomy and endoscopic retrograde cholangiopancreatography （ERCP） for common bile duct stones. Methods The enrollment of the patients was in accordance with 7 criteria. Appropriate 155 patients with cholecystolithiasis and secondary common bile duct stones from December 2007 to June 2015 were divided into three groups： laparoscopic duct exploration and primary suture group （n=62）, laparoscopic duct T-tube drainage and exploration group （n=36） and ERCP ＋ LC group （n=57）. Their all data were recorded and studied prospectively, and patients were followed up after discharge. Results Laparoscopic duct exploration and primary suture group had the least operation time in three groups （P〈0.05）. Laparoscopic duct T-tube drainage and exploration group had the most quantity of postoperative transfusion, the most slow recovery and the most average transfusion quantities （P〈0.05）. ERCP ＋ LC group had the most cost for hospital stay （P〈0.05）. Conclusion Laparoscopic duct exploration and primary suture have the advantage of laparoscopic duct T-tube drainage and exploration and ERCP ＋ LC, there were no significant difference between laparoscopic duct T-tube drainage and exploration and ERCP ＋ LC. The three methods have their own advantages and disadvantages. Patients receive individualized therapy by their specific situation.

关 键 词：胆总管结石 腹腔镜下经胆总管切开一期缝合 腹腔镜下经胆总管切开T管引流 经内镜逆行性胰胆管造影术 腹腔镜下胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]