双镜联合治疗胆总管结石胆总管一期缝合的临床研究  

Clinical study of primary closure of common bile duct of laparoscopy combined with choledochoscope in the treatment of common bile duct stones

作　　者：肖家全[1] 张勇[1] Xiao Jiaquan;Zhang Yong(Department of General Surgery , Ma an shan People’s hospital, An hui Ma an shan, 243000, China)

机构地区：[1]安徽马鞍山市人民医院普外二科

出　　处：《中华普外科手术学杂志（电子版）》2019年第3期314-316,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的 探讨腹腔镜联合胆道镜治疗胆总管结石胆总管一期缝合临床应用价值。方法回顾性分析2015年7月至2017年10月84例胆总管结石患者的病历资料,按手术方式的不同分为A组(27例,行腹腔镜联合胆道镜胆囊切除+胆总管切开取石+胆总管一期缝合术)、B组(29例,行腹腔镜联合胆道镜胆囊切除+胆总管切开取石+T管引流术)和C组(28例,传统的开腹胆囊切除+胆总管切开取石+T管引流术)。应用SPSS22.0统计软件分析数据,一般资料和手术相关指标等计量资料以均数±标准差表示,采用F检验;手术后并发症等采用χ^2检验。P<0.05为差异有统计学意义。结果A组的出血量及术后住院时间均明显低于B组和C组,A组胃肠功能恢复时间明显低于C组,差异均有统计学意义(P﹤0.05)。各组手术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论在把握胆总管一期缝合的手术指征及具备熟练的腹腔镜、胆道镜操作技能下,对于胆囊结石合并胆总管结石患者,腹腔镜联合胆道镜双镜联合下行胆囊切除+胆总管切开取石+胆总管一期缝合术是安全可行的。Objective To investigate the clinical value of primary closure of common bile duct of laparoscopy combined with choledochoscope in the treatment of common bile duct stones. Methods A retrospective analysis of 84 patients with choledocholithiasis from July 2015 to October 2017 was made. According to the different surgical methods, they were divided into group A (27 cases, received laparoscopic cholecystectomy combined with choledochoscopy and choledocholithotomy and primary suture of common bile duct) and group B (29 cases, received laparoscopic cholecystectomy combined with choledochoscopy and choledocholithotomy and T tube drainage) and group C (28 cases, received traditional open cholecystectomy and choledocholithotomy and T tube drainage). The clinical data was analyzed by SPSS 22.0 statistical software , the general data and operation-related indicators were expressed as mean-standard deviation, and examined by F test. The postoperative complications were examined by chi-square test. P <0.05 was statistically significant. Results The amount of bleeding and postoperative hospitalization time in group A were significantly lower than those in group B and C, and the recovery time of gastrointestinal function in group A was significantly lower than that in group C ( P <0.05). There was no significant difference in the incidence of postoperative complications in all groups ( P >0.05). Conclusion It is safe and feasible for patients with cholecystolithiasis and choledocholithiasis to undergo cholecystectomy, choledocholithotomy and primary closure of common bile duct by laparoscopy combined with choledochoscope under the guidance of primary suture of common bile duct and skilled laparoscopy and choledochoscopy.

关 键 词：胆总管结石 腹腔镜 缝合技术 

分 类 号：R657.4[医药卫生—外科学]