"针式法"胆管切开在腹腔镜下胆总管切开探查术中的应用  

Application of needle-type choledochotomy in laparoscopic common bile duct exploration

作　　者：李振南[1] 王谦 刘同泰 姚捷[1] 王小东[1] 张强 孙帅 钱建军[1] 蒋国庆[1] Li Zhennan;Wang Qian;Liu Tongtai;Yao Jie;Wang Xiaodong;Zhang Qiang;Sun Shuai;Qian Jianjun;Jiang Guoqing(Department of Hepatobiliary Panceatic Surgery,Subei People's Hospital of Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院肝胆胰外科,扬州225001

出　　处：《国际外科学杂志》2021年第10期655-659,F0003,共6页International Journal of Surgery

摘　　要：目的介绍腹腔镜下胆总管探查术中,如何运用"针式法"胆管切开及其优点。方法回顾性分析江苏省苏北人民医院2013年1月1日—2020年12月31日实施的1107例腹腔镜下胆总管探查手术患者的资料,根据胆总管切开方式分为两组,采用"针式法"胆总管切开的662例患者设为实验组,采用非"针式法"胆总管切开组的445例患者设为对照组。比较两组患者胆管切开时间、切开时出血率、胆漏发生率、结石复发率和胆管狭窄发生率。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验。计数资料组间比较采用χ2检验或Fisher精确概率法。结果实验组胆管切开时间、出血率分别为(14.45±2.46)s、25.1%,对照组分别为(104.48±15.32)s、68.1%,两组相比差异具有统计学意义(P<0.001)。实验组结石复发率、胆漏发生率和胆管狭窄发生率分别为3.0%、3.6%和0.3%,对照组分别为4.9%、5.6%和0.4%,两组比较差异均无统计学意义(P>0.05)。结论"针式法"胆管切开耗时短,出血少,安全快捷,易于实施,可作为腹腔镜胆总管探查术中胆管切开的常规切开方法。Objective To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods A retrospective analysis for the data of 1107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People's Hospital of Jiangsu Province from January 1,2013 to December 31,2020 were applied.All cases were divided into the study group (662 cases with needle-type choledochotomy)and the control group(445 cases with non-needle-type choledochotomy)according to the manipulation of common bile duct incision.The time-cost,incidences of bleeding and bile leakage,as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups.Normally distributed data were expressed as mean±standard deviation(Mean±SD)and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher's exact test.Results The bile duct incision time and bleeding rate were(14.45±2.46)s and 25.1%in the study group,(104.48±15.32)s and 68.1%in the control group,respectively.The differences between the two groups were statistically significant(P<0.001).The incidence of stone recurrence,biliary leakage,and bile duct stricture were 3.0%,3.6% and 0.3%in the study group,4.9%,5.6% and 0.4%in the control group,respectively.There were no statistically significant differences between the two groups(P>0.05).Conclusion Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving,less bleeding,safe and easy to handling.

关 键 词：胆总管结石 腹腔镜检查 胆总管探查术 胆总管切开术 针式法切开 

分 类 号：R657.4[医药卫生—外科学]