腹腔镜联合胆道镜胆总管切开取石一期缝合的临床应用  

Clinical application of laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture

作　　者：黄庆录[1] 李鸿飞[1] 黄莉桔 黄客增[1] 莫毓[1] 覃强[1] HUANG Qinglu;LI Hongfei;HUANG Liju;HUANG Kezeng;MO Yu;QIN Qiang(Department of General Surgery,Hechi People's Hospital in Guangxi Zhuang Autonomous Region,Hechi 547000,China;Department of Anesthesiology,Hechi People's Hospital in Guangxi Zhuang Autonomous Region,Hechi 547000,China)

机构地区：[1]广西壮族自治区河池市人民医院普通外科,广西河池547000 [2]广西壮族自治区河池市人民医院麻醉科,广西河池547000

出　　处：《中国现代医生》2019年第10期45-49,共5页China Modern Doctor

基　　金：广西壮族自治区河池市科学研究与技术开发计划项目(河科推1623-41)

摘　　要：目的探讨腹腔镜联合胆道镜胆总管切开取石一期缝合的可行性和安全性。方法将2016年6月～2018年8月河池市人民医院收治的行腹腔镜联合胆道镜胆总管切开取石的82例患者作研究对象,根据对胆总管切口的处理方法不同分为研究组和对照组,研究组40例,行胆总管一期缝合术,对照组42例,行T管引流术。比较两组的手术效果和并发症情况。结果两组患者均手术顺利,无中转开腹病例。研究组的手术时间、术中出血量、术后下床活动时间、拔除腹腔引流管时间、住院时间均低于对照组,但差异均无统计学意义(P>0.05)。研究组电解质紊乱的发生率、术后恢复工作时间、住院费用均低于对照组,差异有统计学意义(P<0.05)。研究组手术并发症的发生率均低于对照组,但差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜胆总管切开取石一期缝合治疗肝内外胆管结石,疗效好、恢复快、内环境紊乱少、住院费用低,是安全、可行的。Objective To investigate the feasibility and safety of laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture.Methods 82 patients who underwent laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture from Hechi People's Hospital from June 2016 to August 2018 were enrolled as study objects.They were divided into study group and control group according to the different treatment methods of common bile duct incision.40 patients in the study group underwent primary suture of the common bile duct and 42 patients in the control group underwent T-tube drainage.The surgical outcomes and complications of the 2 groups were compared.Results All the patients in the two groups were operated smoothly and there were no cases of conversion to open surgery.The operation time,intraoperative blood loss,postoperative ambulation time,time of removal of abdominal drainage tube,and hospitalization time were lower in the study group than those in the control group,but the difference was not statistically significant(P>0.05).The incidence of electrolyte disturbance,postoperative recovery time,and hospitalization cost in the study group were lower than those in the control group,and the difference was statistically significant(P<0.05).The incidence of surgical complications in the study group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion Laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture in the treatment of intrahepatic and extrahepatic bile duct stones has good curative effect,rapid recovery,less internal environment disorder and low hospitalization cost.It is safe and feasible.

关 键 词：腹腔镜 胆道镜 胆总管结石 T管引流 一期缝合 

分 类 号：R657.4[医药卫生—外科学]