经胆囊管汇合部微切开行腹腔镜胆总管探查术的应用  

Clinical application of trans-cystic duct microincision at choledochal duct junction during laparoscopic common bile duct exploration

作　　者：兰军良 周博 温自强 许其威 LAN Jun-liang;ZHOU Bo;WEN Zi-qiang(Department of Hepatobiliary-pancreatic Surgery,Linfen People's Hospital,the Seventh Affiliated Hospital to Shanxi Medical University,Linfen 043100,China)

机构地区：[1]临汾市人民医院山西医科大学第七临床医学院肝胆胰外科,山西临汾043100

出　　处：《腹腔镜外科杂志》2023年第5期355-358,共4页Journal of Laparoscopic Surgery

基　　金：临汾市人民医院院级基金项目(T20210512115)。

摘　　要：目的:探讨相较T管引流术,经胆囊管汇合部微切开行胆道镜探查取石一期缝合术治疗胆总管结石的临床疗效及安全性。方法:回顾分析2020年6月至2022年7月行腹腔镜胆总管探查取石术的110例患者的临床资料。根据手术方案分组,其中50例行汇合部微切开(微切开组),60例探查后常规留置T管(对照组)。比较两组手术时间、肛门排气时间、住院时间、住院总费用及术后并发症。结果:微切开组住院时间、肛门排气时间短于对照组(P<0.05);两组手术时间、住院总费用差异无统计学意义(P>0.05);微切开组术后腹腔感染率低于对照组(P<0.05)。结论:相较留置T管,经胆囊管汇合部微切开行胆道镜探查取石一期缝合术治疗胆总管结石安全、可行,可免去患者带T管的痛苦,加快术后康复进程,并有助于降低术后感染的风险,适于具有相关适应证的患者。Objective:To explore the clinical effects and safety of microincision through cystic duct and choledochal duct junction during laparoscopic common bile duct exploration and primary suture versus T-tube drainage in the treatment of choledocholithiasis.Methods:Clinical data of one hundred and ten patients who underwent laparoscopic common bile duct exploration and lithotomy from Jun.2020 to Jul.2022 were retrospectively analyzed.All patients were grouped according to surgery schemes,there were 50 cases of microincision(microincision group)and 60 cases of conventional indwelling T-tube after exploration(control group).The operation time,anal exhaust time,hospital stay,total hospitalization cost and postoperative complications of two groups were compared.Results:The hospital stay and anal exhaust time of the microincision group were significantly shorter than those of the control group(P<0.05).There was no significant difference in operation time and total hospitalization cost between two groups(P>0.05).The incidence of postoperative infection in the microincision group was significantly lower than that in the control group(P<0.05).Conclusions:Compared with T-tube indwelling,microincision through cystic duct and choledochal duct junction,choledochoscopic exploration and primary suture in the treatment of choledocholithiasis is safe and feasible,it can avoid the pain of patients with T-tube,accelerate the postoperative rehabilitation process,and help to reduce the risk of postoperative infection.It is suitable for clinical application in patients with related indications.

关 键 词：胆总管结石病 一期缝合术 胆道镜检查 腹腔镜检查 汇合部微切开 

分 类 号：R657.4[医药卫生—外科学]