腹腔镜胆总管切开取石一期缝合临床疗效分析  

Clinical Effectiveness Analysis of Primary Closure of Common Bile Duct In Laparoscopic Common Bile Duct Exploration

作　　者：曹培 唐祖雄[1] 孙鼎[1] 薛小峰[1] 杨小华[1] 秦磊[1] 钱海鑫[1] CAO Pei;TANG Zuxiong;SUN Ding(Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院普外科,苏州1215006

出　　处：《肝胆外科杂志》2023年第2期94-97,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨改良腹腔镜下胆总管切开取石一期缝合、腹腔镜下胆总管切开取石一期缝合、腹腔镜下胆总管切开取石+T管引流三种术式治疗胆囊结石合并胆总管结石的临床疗效。方法回顾性分析苏州大学附属第一医院在2018年5月~2020年12月间收治的112例胆囊结石合并胆总管结石患者的临床资料。根据手术方式分为T管引流组(40例),一期缝合组(42例)和改良一期缝合组(30例),其中改良一期缝合组暂时保留胆囊管及胆囊,将胆囊逆行游离后离断胆囊动脉,胆囊管予以丝线结扎后将丝线经操作孔拖出体外予以牵拉固定。结果所有患者均顺利完成手术,无中转开腹。改良一期缝合组的手术时间中位数及四分位距141.0(70.0)min短于T管引流组165.0(70.0)min和一期缝合组170.0(67.0)min。三组患者术后第3天的肝功能水平中,谷草转氨酶、谷丙转氨酶、碱性磷酸酶以及γ-谷氨酰转肽酶较术前均有不同程度改善。并发症方面,T管引流组术后出现胆漏、急性胰腺炎和肠梗阻各1例;一期缝合组出现2例发热症状,改良一期缝合组胆漏、发热和急性胰腺炎各1例。改良一期缝合组的引流管拔除时间相比于其他两组无明显优势,但其术后住院天数5.0(2.0)天显著小于T管引流组6.0(4.0)天和传统一期缝合组7.0(4.0)天。术后随访中,三组患者均恢复顺利,目前已完成随访105例。结论对比传统微创术式,改良一期缝合在治疗胆囊结石合并胆总管结石上手术时间及住院天数较短、恢复较快。Objective To determine the clinical effectiveness of laparoscopic common bile duct exploration fllowing an im-proved technique,common primary closure of common bile duct in laparoscopic common bile duct exploration and laparoscopic common bile duct exploration plus T tube drainage in treating cholecystollthiasis with choledocholithiasis.Methods The medical records of 112 patients who suffered from cholecstolthiasis with choledocholithiasis at the First Ailiated Hospital of Soochow University during May,2018 and December,2020 were retrospectively reviewed.These patients were divided into three groups by surgical procedure.They are T tube drainage group(40 samples),common primary closure group(42 samples)and improved technique group(30 samples),the characteristic of the improved technique is that the cystic duct and gallbladder are temporarily preserved,the cystic artery was separated after the gallbladder was retrogradely dissociated,then the cystic duct was ligated with silk and the silk was pulled out through the oper-ation hole.Results All patients underwent laparoscopic surgery.There was no conversion to open surgery.The median(quatile)of improved technique group 141.0(70.0)min is shorter than that of T tube drainage group 165.0(70.0)min and common primary closure group 170.0(67.0)min.The liver function of all patients improved to varying degrees three days after surgery,including as-partate aminotransferase,alanine aminotansferase,alkaline phosphatase and r-glutamyl transpeptidase.In perioperative complication,1 case each of biliary fistula,acute pancreatitis and intestinal obstruction in T tube drainage group;2 cases of fever symptoms in com-mon primary closure group and 1 case each of biliary fistula,fever and acute pancreatitis in improved technique group.Compared with the other two groups,drainage tube exelcymosis time of improved technique group had no obvious advantage,but hospitalization dura-tion5.0(2.0)days of improved technique group were less than that in T tube drainage group 6.0(4.0)days and comm

关 键 词：胆总管结石 T管引流 改良 一期缝合 

分 类 号：R657.4[医药卫生—外科学]