腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中的应用  

Application of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones

作　　者：冯其柱[1,2] 王思雨 袁文康 张超 Feng Qizhu;Wang Siyu;Yuan Wenkang;Zhang Chao(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230001,China;Department of General Surgery,the First Hospital of Anhui University of Science and Technology,Huainan 232007,China)

机构地区：[1]安徽医科大学第一附属医院普通外科,合肥230001 [2]安徽理工大学第一附属医院普通外科,安徽省淮南市232007

出　　处：《中华肝脏外科手术学电子杂志》2023年第1期68-72,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：安徽高校自然科学研究基金资助重点项目(KJ2021A0439);淮南市指导性科技计划项目(2021066)。

摘　　要：目的探讨腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中应用的可行性。方法回顾性分析2020年1月至2021年12月在安徽医科大学第一附属医院行腹腔镜胆总管探查一期缝合的66例胆总管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男31例,女35例;年龄13~81岁,中位年龄57岁。根据胆总管直径将患者分为正常组(27例)和扩张组(39例)。正常组胆总管平均直径为(7.4±0.5)mm,扩张组为(12.8±2.4)mm。术中均采用腹腔镜胆囊切除术+腹腔镜胆总管探查术+胆道镜取石+胆总管一期缝合。观察两组患者围手术期情况和并发症发生情况。两组手术时间等比较采用秩和检验,胆漏发生率比较采用Fisher确切概率法。结果正常组手术时间、术后住院时间和住院费用中位数分别为115(45)min、4(2)d、2.1(0.6)万元,扩张组相应为120(62)min、4(3)d、2.0(0.8)万元,两组差异均无统计学意义(Z=-0.235,-0.375,0.633;P>0.05)。正常组围手术期发生胆漏2例,经通畅引流、营养支持等保守治疗治愈;扩张组未发生胆漏;两组术后胆漏发生率比较差异无统计学意义(P=0.164)。两组术后3个月彩超均未见结石残留。随访期间两组均未出现胆管炎、胆道狭窄和胆道结石复发。结论腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中应用安全、有效,不会增加住院时间、住院费用和术后并发症。Objective To evaluate the feasibility of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones.Methods Clinical data of 66 patients with common bile duct stones who underwent laparoscopic exploration and primary closure in the First Hospital of Anhui Medical University from January 2020 to December 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,31 patients were male and 35 female,aged from 13 to 81 years,with a median age of 57 years.All patients were divided into the normal(n=27)and dilation groups(n=39)according to the diameter of common bile duct.The average diameter of common bile duct was(7.4±0.5)mm in the normal group and(12.8±2.4)mm in the dilation group.Laparoscopic cholecystectomy+laparoscopic common bile duct exploration+choledochoscopic lithotomy+primary closure of common bile duct were employed in all cases.Perioperative conditions and postoperative complications were observed between two groups.The operation time between two groups was compared by rank-sum test.The incidence of bile leakage was compared by Fisher's exact test.Results In the normal group,the median operation time,length of postoperative hospital stay and hospitalization expenses were 115(45)min,4(2)d and 2.1(0.6)×104 Yuan,and 120(62)min,4(3)d and 2.0(0.8)×104 Yuan in the dilation group,and no significant difference was observed between two groups(Z=-0.235,-0.375,0.633;P>0.05).In the normal group,biliary leakage occurred in 2 cases during perioperative period,which was cured by conservative treatment,such as drainage and nutritional support,etc.No bile leakage occurred in the dilation group.No significant difference was noted in the incidence of bile leakage between two groups(P=0.164).No residual stone was founded in two groups by Color Doppler ultrasound at postoperative 3 months.During postoperative follow-up,no cholangitis,biliary stricture and recurrence of bi

关 键 词：胆总管结石 腹腔镜 腹腔镜胆总管探查术 一期缝合 

分 类 号：R65[医药卫生—外科学]