腹腔镜胆总管探查一期缝合治疗复杂性胆总管结石  

Primary bile duct suture after common bile duct exploration in the treatment of complex common bile duct stones

作　　者：何辉虎 鲁正 胡孔旺 姚启杨 张士节 张萌 徐如彬 李力 HE Hui-hu;LU Zheng;HU Kong-wang(Department of General Surgery,Fuyang Hospital,Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学附属阜阳医院普外科,合肥236000

出　　处：《肝胆外科杂志》2023年第1期23-26,共4页Journal of Hepatobiliary Surgery

基　　金：2021年安徽省卫生健康委科研项目立项项目(基金号:AHWJ2021b138)。

摘　　要：目的探讨对于复杂性胆总管结石行腹腔镜下胆总管探查(Laparoscopic common bile duct exploration,LCBDE)术后,同时行胆总管一期缝合的安全性及可行性研究.方法回顾性分析2019年12月~2022年09月我科收治的75例复杂性胆总管结石患者的临床资料,根据手术方式不同分为胆管一期缝合组(Primary duct closure,PDC)和T管外引流组(T tube drainage,TTD),其中30例行LCBDE+PDC术,45例行LCBDE+TTD术,比较两组患者性别、年龄、术前合并症、术前白细胞水平、手术时间、术胆总管直径、最大结石直径、结石数目、住院费用、术后并发症、术后住院时间等围术期资料.结果两组在性别、年龄BMI、术前合并症等一般资料中差异无统计学意义;一期缝合组和T管组的手术时间分别为(110.30±18.81)min、(157.56±51.88)min,术中出血量分别为(19.57±14.88)ml、(32.89±30.85)ml,引流管拔除时间分别为(5.03±0.98)d、(6.02±1.74)d,术后住院时间分别为(6.50±1.63)d、(9.20±3.14)d,住院费用分别为(23028.37±3590.62)元、(31514.16±9977.78)元差异有统计学意义;其余在胆管直径、最大结石直径、术后并发症等方面差异均无统计学意义(P>0.05).结论复杂性胆管结石患者并非是胆管一期缝合的禁忌症,在术者有足够的腔镜手术经验、充分暴露胆管、取净结石的前提下行胆管一期缝合是安全可行的.Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration(LCBDE)after operation of complex choledocholithiasis.Methods The clinical data of 75 cases of complex choledocholithias admitted to our department from December 2019 to September 2022 were retrospectively analyzed,divided into Primary duct closure group and T tube drainage group according to surgical mode.TTD),including 30 patients undergoing LCBDE+PDC and 45 patients undergoing LCBDE+TTD.The perioperative data of the two groups were compared,including gender,age,preoperative comorbidities,preoperative white blood cell level,operation time,intraoperative diameter of common bile duct,maximum stone diameter,stone number,hospitalization cost,postoperative complications,postoperative hospital stay and so on.Results There was no significant difference in gender,age,BMI and preoperative complications between the two groups.The operative time of PDC group and TTD group were 110.30±18.81 min and 157.56±51.88min,respectively,and the intraoperative blood loss were 19.57±14.88ml and 32.89±30.85ml,respectively.The removal time of drainage tube was 5.03±0.98(d),6.02±1.74(d),and the postoperative hospitalization time was 6.50±1.63(d),9.20±3.14(d),respectively.The hospitalization expenses were 23028.37±3590.62(yuan)and 31514.16±9977.78(yuan)respectively,and the difference was statistically significant.There were no significant differences in bile duct diameter,maximum stone diameter and postoperative complications(P>0.05).Conclusion Primary bile duct suture is not contraindicated in patients with complex bile duct calculi.Primary bile duct suture is safe and feasible under the premise that the operator has enough experience in endoscopic surgery,fully exposed bile duct and removed stone.

关 键 词：胆管一期缝合 T管引流 复杂性胆管结石 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]