胆囊管汇入部微切开行腹腔镜下胆总管探查术治疗细径胆总管结石的疗效分析  

Efficacy of laparoscopic common bile duct exploration in the treatment of choledocholithiasis with small common bile duct by microincision through the cystic duct confluence

作　　者：鲁俊[1] 姜友[1] 刘家阳 李良[1] Lu Jun;Jiang You;Liu Jiayang;Li Liang(Department of Hepatobiliary Surgery,Hefei Second People's Hospital(Hefei Hospital Affilated to Anhui Medical University),Hefei 230011,China)

机构地区：[1]合肥市第二人民医院(安徽医科大学附属合肥医院)肝胆外科,合肥230011

出　　处：《中华肝胆外科杂志》2024年第4期271-275,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：蚌埠医学院科技项目(2022byzd215)。

摘　　要：目的评估胆囊管汇入部微切开行腹腔镜下胆总管探查术治疗细径胆总管结石的安全性和有效性。方法回顾性分析2014年2月至2021年4月合肥市第二人民医院收治的114例胆囊结石合并细径胆总管结石患者的临床资料,其中男性57例,女性57例,年龄(51.3±15.8)岁。46例行汇入部微切开胆总管探查后一期缝合的患者为微切开组,68例行胆总管切开探查后留置T管的患者为T管组,对两组患者的基线资料、影像学检查结果以及术中和术后临床指标进行分析比较。结果两组患者的基线资料具有可比性(均P>0.05)。微切开组中转开腹率2.2%(1/46),T管组中转开腹率2.9%(2/68),两组比较差异无统计学意义(P=1.000)。与T管组相比,微切开组具有更少的术中出血量[5.0(5.0,10.0)ml比10.0(5.0,10.0)ml,P=0.043]以及更短的手术时间[(85.2±32.1)min比(102.8±39.5)min,P=0.012]、引流管拔管时间[(5.1±1.2)d比(6.6±1.3)d,P=0.031]和术后住院时间[(6.5±1.7)d比(7.4±2.8)d,P=0.025],差异均具有统计学意义。微切开组的液电碎石使用率为4.3%(2/46),T管组为8.8%(6/68),差异无统计学意义(P=0.471)。微切开组和T管组患者术后并发症发生率分别为4.3%(2/46)和11.8%(8/68),两组比较差异无统计学意义(P=0.311)。截至随访结束时,所有患者均未发现结石复发和胆管狭窄。结论在选择合适病例的前提下,腹腔镜下胆囊管汇入部微切开治疗细径胆总管结石是安全和有效的。Objective To evaluate the safety and efficacy of laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with small common bile duct(CBD)by microincision through the cystic duct confluence.Methods Clinical data of 114 patients with cholecystolithiasis with fine diameter of CBD treated in Hefei Second People's Hospital from February 2014 to April 2021 were retrospectively analyzed,including 57 males and 57 females,aged(51.3±15.8)years old.Among them,46 patients underwent primary closure after LCBDE by microincision through the cystic duct confluence(microincision group),and 68 patients underwent T-tube drainage after transductal LCBDE(T-tube group).Baseline data,imaging findings,and intraoperative and postoperative clinical data of the two groups were analyzed.Results Baseline data were comparable between the two groups(all P>0.05).The conversion rate was 2.2%(1/46)in the microincision group and 2.9%(2/68)in the T-tube group(P=1.000).Compared to the T-tube group,the microincision group had less intraoperative blood loss[5.0(5.0,10.0)ml vs.10.0(5.0,10.0)ml,P=0.043],shorter operative time[(85.2±32.1)min vs.(102.8±39.5)min,P=0.012],earlier postoperative removal of drainage[(5.1±1.2)d vs.(6.6±1.3)d,P=0.031],and shorter postoperative hospital stay[(6.5±1.7)d vs.(7.4±2.8)d,P=0.025].The utilization rate of electro-hydraulic lithotriptic was 4.3%(2/46)in the microincision group and 8.8%(6/68)in the T-tube group(P>0.05).The incidence of complications was 4.3%(2/46)in the microincision group and 11.8%(8/68)in the T-tube group,with no significant difference between the two groups(P=0.311).There were no cases of biliary stricture and recurrence of stone in either group during follow-up.Conclusion In selected cases,it could be safe and effective to treat choledocholithiasis with fine diameter of CBD by LCBDE through the microincision of the cystic duct confluence.

关 键 词：腹腔镜 细径胆总管结石 胆总管探查 汇入部微切开 

分 类 号：R657.4[医药卫生—外科学]