胆总管结石不伴胆囊结石不同微创治疗方法的疗效对比分析  

A comparative study of the clinical efficacy of minimally invasive treatment of choledocholithiasis without cholecystolithiasis

作　　者：许维[1] 吴鹏 宋劲松[1] Xu Wei;Wu Peng;Song Jingsong(Department of General Surgery,Tianmen First People's Hospital,Hubei Tianmen 431700,China)

机构地区：[1]天门市第一人民医院普外科

出　　处：《腹部外科》2019年第6期454-458,共5页Journal of Abdominal Surgery

摘　　要：目的研究不同微创方式治疗胆总管结石不伴有胆囊结石的临床效果。方法回顾性分析天门市第一人民医院近3年胆总管结石不伴胆囊结石手术治疗的83例病人临床资料,其中行腹腔镜下胆总管切开取石一期缝合术、术中保留胆囊21例(A组);行腹腔镜下胆总管切开取石一期缝合术、术中切除胆囊25例(B组);行腹腔镜下胆囊切除术+腹腔镜下胆总管切开取石术+T管引流术18例(C组);行内镜下十二指肠乳头括约肌切开取石术19(D组)。观察4组的治疗过程、术后恢复情况等相关临床指标。结果A组术后未出现胆瘘、结石残留等并发症,且随访24个月以上均未见结石复发;B组术后1例病人出现胆瘘,1例病人术后第18个月时复发胆总管结石;C组术后2例病人发现胆道残余结石,1例病人术后24个月时复发肝胆管结石;D组术后2例病人出现水肿性胰腺炎,1例在术后第9个月时出现反流性胆管炎,术后18个月时复发胆总管结石。4组病人在手术时间、术后住院时间等方面差异有统计学意义(P<0.05)。结论4种微创方式对胆总管结石不伴胆囊结石的治疗各有利弊,临床需根据病人的情况采用个体化方式进行选择;对于胆总管结石不伴有胆囊结石且胆囊功能良好的病人,行保留胆囊的腹腔镜下胆总管切开取石一期缝合术是安全、有效的。Objective To study the clinical efficacy of different minimally invasive treatment of common bile duct stones without gallstones.Methods The clinical data of 83 patients with choledocholithiasis without gallstones in Tianmen First People′s Hospital in recent 3 years were analyzed retrospectively.Among them,21 patients underwent laparoscopic choledocholithotomy with primary suture and retained gallbladder during operation(Group A);25 patients underwent laparoscopic choledocholithotomy with primary suture and removed gallbladder during operation(Group B);18 patients underwent laparoscopic cholecystectomy+laparoscopic choledocholithotomy+T-tube drainage(Group C);19 patients underwent endoscopic sphincterotomy(Group D).The treatment process,postoperative recovery and other related clinical indicators among the four groups were compared and analyzed.Results In group A,there was no postoperative complications such as biliary fistula and residual stones occurred,and no stone recurrence after 24 months of follow-up.In group B,One patient had biliary fistula and one patient had recurrent common bile duct stone at 18 months after operation.In group C,Residual biliary stones were found in 2 patients after operation.Hepatolithiasis recurred in 1 patient at 24 months after operation.In group D,2 patients had edematous pancreatitis and 1 had recurrent common bile duct stone at 9 months after operation.The differences in the operation time and postoperative hospital stay between the four groups had statistical significance(P<0.05).Conclusion Treatment of 4 types of minimally invasive surgery without cholecystolithiasis in common bile duct stones have advantages and disadvantages,the individualized treatment should be tailored according to the condition of patients.The laparoscopic common bile duct exploration and cholecystectomy is a safe and effective procedure for patients with common bile duct stones without cholecystolithiasis.

关 键 词：胆总管结石 保留胆囊 微创治疗 

分 类 号：R657.4[医药卫生—外科学]