腹腔镜胆总管切开纤维胆道镜取石胆总管一期缝合的疗效观察  

Laparoscopic choledocholithotomy and fiber choledochoscopy for primary suture of the common bile duct

作　　者：丁汝梅 张朝贵 石野 赵国强 Ding Rumei;Zhang Chaogui;Shi Ye;Zhao Guoqiang(Guizhou Orthopedic Hospital,Guiyang,Guizhou,550000,China)

机构地区：[1]贵州省骨科医院

出　　处：《当代医学》2020年第8期20-23,共4页Contemporary Medicine

摘　　要：目的分析腹腔镜胆总管切开纤维胆道镜取石胆总管一期缝合的疗效。方法选择本院2017年1月至2019年1月收治的80例行胆总管取石一期缝合术患者为研究对象,按照随机数表法分为对照组和观察组,各40例。观察组行腹腔镜胆总管切开纤维胆道镜取石胆总管一期缝合治疗,不留置T管;对照组则留置T管。比较两组患者取石成功率、手术时间、术中出血量、术后疼痛程度、腹腔引流时间、肛门排气时间、恢复进食时间、住院时间、住院费用、并发症发生率。结果观察组患者取石成功率为97.50%(39/40),1例因胆管炎症严重,结石较大,为避免一期取石不净,术后留置T管;对照组取石成功率为95%(38/40),1例因止血困难中转开腹,1例因胆总管末端结石嵌顿取石不易中转开腹,两组患者取石成功率比较差异无统计学意义;两组患者手术时间[(81.95±17.33)min vs.(87.48±19.29)min]、术中出血量[(31.74±6.21)mL vs.(34.26±5.89)mL]、术后VAS评分[(2.76±1.07)分vs.(2.88±1.32)分]比较差异无统计学意义;观察组腹腔引流时间[(3.23±1.07)d vs.(4.31±1.45)d]、恢复进食时间[(1.57±1.22)d vs.(2.64±1.58)d]、住院时间[(6.49±1.81)d vs.(9.36±2.73)d]、住院费[(16 894±736)元vs.(19 473±824)元]均显著低于对照组(P<0.05),肛门排气时间与对照组比较差异无统计学意义;观察组术后并发症发生率(7.50%vs. 17.50%)显著低于对照组(P<0.05)。结论采用腹腔镜胆总管切开纤维胆道镜取石胆总管一期缝合术治疗肝外胆管结石伴胆囊结石,疗效确切,安全性良好,且术后不留置T管,更有助于促进患者恢复。Objective To analyze the effect of laparoscopic choledocholithotomy with fiber choledochoscope for single stage suture of common bile duct. Methods 80 patients with primary suture for choledocholithotomy admitted to our hospital from January 2017 to January 2019 were selected as research objects. According to the random number table method, the patients were divided into control group and observation group, with 40 cases in each group, the observation group underwent primary suture of choledocholithotomy with fiberoptic choledochoscopy for choledocholithotomy without T tube indwelling. The T tube was retained in the control group. The success rate of stone removal, operation time, intraoperative blood loss, postoperative pain, abdominal drainage time, anal exhaust time, feeding recovery time, hospital stay, hospital expenses and incidence of complications were compared between the two groups. Results In the observation group, the success rate of stone removal was 97.50%(39/40). One patient had severe bile duct inflammation and large stones. In order to avoid the impurity of the first stone removal, the T tube was placed postoperatively. The success rate of stone removal in the control group was 95%(38/40), 1 case was transferred to laparotomy due to hemostasis difficulty, and 1 case was not transferred to laparotomy due to stone incarceration at the end of the common bile duct, and the difference in the success rate of stone removal was not statistically significant. There was no significant difference in operation time [(81.95±17.33) min vs.(87.48±19.29) min], intraoperative blood loss [(31.74±6.21) mL vs.(34.26±5.89) mL] and postoperative VAS score [(2.76±1.07) scores vs.(2.88±1.32) scores] between the two groups. Abdominal drainage time [(3.23±1.07) d vs.(4.31±1.45) d ], feeding time [(1.57±1.22) d vs.(2.64±1.58) d], hospitalization time [(6.49±1.81) d vs.(9.36±2.73) d] and hospitalization expenses [(16 894±736) yuan vs.(19 473±824) yuan] were significantly lower in the observation group than in

关 键 词：腹腔镜 胆道镜 胆总管结石 胆总管切开 一期缝合 

分 类 号：R657.42[医药卫生—外科学]