腹腔镜下经胆囊管胆总管汇合部微切开胆总管探查取石并一期缝合临床效果分析  

Clinical analysis of laparoscopic micro incision at the confluence of the gallbladder and common bile ducts for exploring and removing stones and primary suturing of the common bile ducts

作　　者：张骏 康健 ZHANG Jun;KANG Jian(Department of General surgery,YouAnMen hospital,Fengtai,Beijing 100059,China)

机构地区：[1]北京丰台右安门医院普通外科,北京100059

出　　处：《肝胆外科杂志》2023年第6期419-421,470,共4页Journal of Hepatobiliary Surgery

摘　　要：目的 探讨腹腔镜下经胆囊管胆总管汇合部微切开胆总管探查取石并一期缝合的临床效果及安全性.方法 回顾性分析2018年1月至2023年1月在我院行腹腔镜下经胆囊管胆总管汇合部微切开胆总管探查取石并一期缝合的患者,按照手术处理方式分为两组,其中一期缝合组(观察组)189例,T管引流组(对照组)147例.观察两组患者在围手术期手术安全性等观察指标间的差异.结果 两组共336例患者均在腹腔镜下完成手术,且两组患者一般资料基线一致(P>0.05).在手术时间、术后切口区域疼痛情况、术后住院时间方面,两组差异存在统计学意义(P<0.05).观察组2例出现胆漏,对照组2例出现胆漏,均经过通畅引流等保守治疗方式治愈,两组差异无统计学意义(P>0.05).两组患者均未出现术后胆道狭窄(P>0.05).观察组3例术后胆管残留结石,通过内镜下取出,对照组2例术后胆管残留结石,术后8周经T管窦道胆道镜下取出,两组差异无统计学意义(P>0.05).另外,两组在术中出血量、术中明确的非预期胆道损伤、术后引流管携带时间、术后胃肠道恢复时间方面,两组无统计学差异(P>0.05).结论 腹腔镜下经胆囊管胆总管汇合部微切开胆总管探查取石并一期缝合可以有效缩短手术时间,缩短术后住院时间,降低患者术后疼痛程度及发生率,对于胆总管未扩张的胆总管结石合并胆囊结石患者是一种安全、有效、可行的手术方式.Objective To explore the clinical effect and safety of laparoscopic micro incision of the common bile duct through the confluence of the gallbladder and common bile duct for exploration and removal of stones and primary suture.Methods Clinical data of 336 patients undergoing laparoscopic micro incision of the common bile duct through the confluence of the gallbladder and com-mon bile duct for exploration and removal of stones and primary suture in Beijing Fengtai YouAnMen Hospital from January 2018 to Jan-uary 2023 were retrospectively analyzed.They were separate by two groups,including 189 cases with primary suture of confluence of gallbladder duct and common bile duct(observation group)and 147 cases with T tube drainage of common bile duct(control group).Clinical differences during perioperative period were compared between two groups.Results All the 336 patients underwent laparo-scopic operation successfully.The baseline of general data was consistent between the two groups(P>0.05).There were significant differences in operation time,postoperative pain in incision area,postoperative hospitalization days between the two group(P<0.05).2 case in observation group and 2 cases in control group presented bile leakage.All the 4 cases who presented bile leakage were success-ful cure by conventional treatment.There were no significant differences between the two group(P>0.05).There was no postoperative biliary stricture in both groups(P>0.05).There was 3 cases presented residual calculus of bile duct after operation which removed by endoscopy in observation group and 2 cases in control group which removed by choledochoscope through T-tube sinus at the time of 8 weeks after operation.There were no significant differences between the two group(P>0.05).There were no significant differences in blood loss,definite unexpected bile duct injury during operation,days of drainage tube after operation,postoperative recovery time of gastrointestinal tract between the two group(P>0.05).Conclusion Laparoscopic micro incision of the

关 键 词：腹腔镜 胆囊管胆总管汇合部微切开 胆总管探查取石 一期缝合 

分 类 号：R657.4[医药卫生—外科学]