双镜探查后一期缝合治疗老年胆囊结石合并胆总管结石的临床疗效分析  

Clinical effect of primary suture after two-endoscopic exploration in the treatment of elderly patients with cholecystolithiasis and choledocholithiasis

作　　者：李进昂 瞿康林 庞青 满忠然[1] 周帅 陈石磊 刘会春[1,2] Li Jin’ang;Qu Kanglin;Pang Qing;Man Zhongran;Zhou Shuai;Chen Shilei;Liu Huichun(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Hepatopancreatobiliary Surgery,Anhui No.2 Provincial People’s Hospital,Hefei 233041,China)

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,233004 [2]安徽省第二人民医院肝胆胰外科,合肥233041

出　　处：《中华普通外科学文献（电子版）》2022年第3期183-187,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：安徽省学术和技术带头人及后备人选科研活动经费资助项目(2018D194);安徽省自然科学基金杰出青年项目(2008085J37);蚌埠医学院第一附属医院杰出青年项目(2019byyfyjq05);蚌埠医学院自然科学研究重点项目(BYKY1858ZD)。

摘　　要：目的探讨腹腔镜胆道镜探查(LCBDE)+腹腔镜胆囊切除术(LC)后行一期缝合在治疗老年胆囊结石合并胆总管结石患者中的疗效。方法回顾性分析2019年6月至2021年6月在蚌埠医学院第一附属医院肝胆外科治疗的78例胆囊结石合并胆总管结石的老年患者资料,患者均行LC+LCBDE治疗,按术中残端胆管的处理方式不同分为两组:一期缝合组38例,胆管切开取石后直接进行一期缝合;T管引流组40例,胆管切开取石后留置T管。比较两组患者术前基本资料、术中情况,术后第1天的C反应蛋白水平、NRS疼痛评分,术后第3天的VTE风险评分,住院情况、术后并发症情况以及结石复发、残留情况。结果患者均完成LC+LCBDE手术,一期缝合组在手术时间、首次进食时间、术后第1天C反应蛋白水平、NRS疼痛评分、腹腔引流管拔除时间、首次下床时间、术后住院时间、住院费用方面,均优于T管引流组(P<0.05);而两组术中出血量、术后第3天VTE风险评分以及术后并发症、结石残留与复发情况比较,差异均无统计学意义。结论在把握适应证的条件下,对老年胆囊结石合并胆管结石患者行LC+LCBDE+胆总管一期缝合较T管引流更具优势,患者术后恢复更快、疼痛更轻。双镜探查后行一期缝合安全有效,且符合加速康复外科的理念,值得临床上推广应用。Objective To investigate the efficacy of laparoscopic common bile duct exploration(LCBDE)+laparoscopic cholecystectomy(LC)followed by primary suture in the treatment of elderly patients with cholecystolithiasis and choledocholithiasis.Methods The data of 78 elderly patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College from June 2019 to June 2021 were retrospectively analyzed.All patients were treated with LC+LCBDE and divided into two groups according to the different treatment methods of residual bile duct during operation:38 cases in the primary suture group,undergoing primary suture directly after bile duct incision and stone extraction;40 cases in the T-tube drainage group,with bile duct incision after stone indwelling T tube.The preoperative basic information,intraoperative conditions,C-reactive protein level and NRS pain score on the first postoperative day,VTE risk score on the third postoperative day,hospitalization,postoperative complications,and residual status were compared between the two groups.Results All patients underwent LC+LCBDE surgery,and the primary suture group was superior to the T-tube drainage group in terms of operation time,first feeding time,the level of C-reactive protein on the first postoperative day,NRS pain score on the first postoperative day,abdominal drainage tube removal time,the first out-off-bed time,postoperative hospital stay and hospitalization cost(all P<0.05).There were no significant differences in intraoperative blood loss,VTE risk score on the third day after surgery,postoperative complications,stone residue and recurrence between the two groups.Conclusions By grasping the indications,LC+LCBDE+common bile duct primary suture has certain advantages over T-tube drainage for elderly patients with cholecystolithiasis and choledocholithiasis,with faster recovery and less pain.Primary suture after two-endoscopies exploration is safe and effective,a

关 键 词：胆总管结石 一期缝合 T管引流 老年 

分 类 号：R657.4[医药卫生—外科学]