LC+LCBDE术后胆管一期缝合治疗胆囊结石合并正常直径胆总管结石的临床研究  

Laparoscopic common bile duct exploration and cholecystectomy combined with primary suture for the treatment of cholecysto-choledocholithiasis with normal diameter common bile duct

作　　者：汤晓东[1] 刘双海[1] 陈达伟 贾竞超[1] TANG Xiaodong;LIU Shuanghai;CHEN Dawei;JIA Jingchao(Department of Hepatopancreatobiliary Surgery,Yushanwan District,Jiangyin People’s Hospital,School of Medicine,Southeast University,Jiangyin,Jiangsu 214400,China)

机构地区：[1]东南大学医学院附属江阴医院敔山湾院区肝胆胰外科,江苏江阴214400

出　　处：《肝胆胰外科杂志》2022年第1期14-18,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并正常直径胆总管结石术后胆管一期缝合的可行性和安全性。方法回顾性分析东南大学医学院附属江阴医院自2016年1月至2019年12月256例由同一主刀医师采用LC+LCBDE治疗胆囊结石合并胆总管结石患者的临床资料。根据胆总管直径的粗细分为正常直径组(6 mm≤胆总管直径≤8 mm,A组)和胆管扩张组(胆总管直径>8 mm,B组),其中A组82例,B组174例。结果A组男34例,女48例,年龄(55.3±15.2)岁;B组男78例,女96例,年龄(57.0±15.8)岁。A组与B组患者手术成功率分别为98.8%和98.9%,手术时间分别为(98.7±28.8)min和(96.1±29.3)min、术后腹腔引流时间分别为(6.0±2.0)d和(6.2±1.8)d,术后住院时间分别为(7.8±1.9)d和(7.6±1.4)d、住院费用分别为(25436.4±3894.9)元和(25188.8±3910.4)元,两组比较差异无统计学意义(均P>0.05)。两组患者除近期并发症胆管狭窄比较差异有统计学意义外(P<0.05)外,其余在胆漏、出血、胆管狭窄等术后总并发症的发生率及远期随访结果方面,差异无统计学意义(P>0.05)。结论只要选择合适的病例,LC+LCBDE术后胆管一期缝合治疗胆囊结石合并正常直径胆总管结石是安全、可行的,值得临床中推广应用。Objective To investigate the feasibility and safety of laparoscopic common bile duct exploration(LCBDE)and cholecystectomy(LC)combined with primary suture for the treatment of cholecysto-choledocholithiasis with normal diameter common bile duct.Methods The clinical data of patients with cholecysto-choledocholithiasis treated by the same surgeon with LC+LCBDE in Jiangyin Hospital Affiliated to School of Medicine,Southeast University from Jan.2016 to Dec.2019 were retrospectively analyzed.According to the diameter of the common bile duct,patients were divided into normal diameter group(6 mm≤common bile duct diameter≤8 mm,Group A)and choledochal dilatation group(common bile duct diameter>8 mm,Group B).Group A included 82 cases of patients and Group B included 174 cases.Results There were 34 males and 48 females in Group A,aged(55.3±15.2)years.There were 78 males and 96 females in Group B,aged(57.0±15.8)years.The surgical success rate of were 98.8%in Group A and 98.9%in Group B.There were no significant differences between two groups in the operation time[(98.7±28.8)min vs(96.1±29.3)min],the postoperative abdominal drainage time[(6.0±2.0)d vs(6.2±1.8)d],the postoperative hospital stay[(7.8±1.9)d vs(7.6±1.4)d],and the hospitalization expenses[(25436.4±3894.9)yuan vs(25188.8±3910.4)yuan].Except for the recent bile leakage(P<0.05),there were no significant differences in the incidence of postoperative complications such as bile leakage,bleeding,bile duct stenosis and long-term follow-up results(all P>0.05).Conclusion As the appropriate cases are selected,it is safe and feasible to use laparoscopic common bile duct exploration and cholecystectomy combined with primary suture for the treatment of cholecysto-choledocholithiasis with normal diameter common bile duct.It is worthy of clinical application.

关 键 词：腹腔镜 胆总管探查术 胆囊切除术 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]