腹腔镜胆管探查治疗胆囊结石伴肝外胆管结石临床分析  

Clinical experienceal LBCDE for gallbladder stones and common bile duct stones

作　　者：杨英祥 刘彻 吴印涛 张鸿 安阳 刘鹏 邱宝安 赵文超 YANG Yingxiang;LIU Che;WU Yingtao;ZHANG Hong;AN Yang;LIU Peng;QIU Baoan;ZHAO Wenchao(Department of Hepatobiliary Surgery,The Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,china)

机构地区：[1]中国人民解放军总医院第六医学中心肝胆外科,北京100048

出　　处：《中国急救复苏与灾害医学杂志》2020年第10期1207-1209,1213,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市科学技术委员会"首都临床特色应用研究"专项资助课题(编号:Z1710000417049)。

摘　　要：目的 探讨腹腔镜手术治疗胆囊结石伴肝外胆管结石的选择.方法 回顾性分析2013年1月—2019年6月解放总医院第六医学中心276例胆囊结石并胆管结石接受腹腔镜下胆囊切除胆总管探查取石患者的临床资料,分析治疗效果及安全性.结果 255例完成腹腔镜胆管探查术,施行LC+LCBDE181例,其中68例行胆总管一期缝合,113例放置T管引流;施行LC+LTCBDE74例.各组在年龄、胃肠道功能恢复时间、胆漏发生、术中出血量、残余结石等统计指标上均无明显差异(P>0.05).LC+LTCBDE组手术时间(118.7±26.2)min和术后住院时间(5.8±1.6)d比LC+LCBDE+T管组[(135.3±32.1)min和(8.5±2.1)d]短(P<0.05).并发症发生率5.9%(15/255),胆漏经保守治愈,全组无死亡.结论 腹腔镜胆管探查安全微创,宜根据患者条件作最适合的手术方案选择,达到最佳治疗效果.Objective To investigate the selection method of laparoscopie surgery for gallbladder stones and Choledocho-litiasis.Methods The clinical data of 276 patients with cholecystolithiasis combined with common bile duct stones who underwent laparoscopic cholecystectomy and common bile duct exploration were retrospectively analyzed.Retro-spective analysis was done on ffet and safety of laparoscopic surgery.Results LC combined with LCBDE or LTCBDE was performed in 255 cases.There were 68 cases who treated by LCBDE combined with primary closure and 113 cases who treated by LCBDE combined with T tube drainage.LC combined with LTCBDE was performed in 74 cases.There were no significant differences in age,volume of intraoperative blood loss,recovery time of postoperative gastrointesti-nal function,bile leakage and cases of residual stones among the three groups.LTCBDE had shorter operative time[(118.7±26.2)minutes vs.(135.3±32.1)minutes]and post-operative hospitalization time[(5.8±1.6)days vs.(8.5±2.1)days]compared with LCBDE combined with T tube drainage(P<0.05).Postoperative complication was 5.9%.Bile leak-age was transient;none required any auxiliary procedure.there no death.Conclusion It is reliable and minimally inva-sive to manage cholecystolithiasis comnbined with common bile duet stones with laparoscopy common bile duct explora-tion.The best treatment is according Preoperative evaluation and intraoperative finding to select.

关 键 词：胆总管结石 腹腔镜 经胆囊管胆总管探查 胆囊结石 胆总管探查 

分 类 号：R364.25[医药卫生—病理学]