PTCD序贯腹腔镜胆总管探查一期缝合治疗胆总管结石合并中重度急性胆管炎疗效分析  

Clinical efficacy of sequential PTCD and primary closure of common bile duct after laparoscopic common bile duct exploration in treatment of choledocholithiasis complicated with moderate and severe acute cholangitis

作　　者：魏勇 王勇 衣时明 成雨 Wei Yong;Wang Yong;Yi Shiming;Cheng Yu(Department of Hepatobiliary-Pancreatic-Splenic Surgery,Yantai Hospital Affiliated to Binzhou Medical University,Yantai 264100,China)

机构地区：[1]滨州医学院烟台附属医院肝胆胰脾外科,烟台264100

出　　处：《中华肝胆外科杂志》2024年第7期505-508,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨序贯应用经皮肝穿刺胆道引流(PTCD)、腹腔镜胆总管探查一期缝合治疗胆总管结石合并中重度急性胆管炎的临床疗效。方法回顾性分析滨州医学院烟台附属医院2021年1月至2023年8月收治的127例胆总管结石合并急性胆管炎患者的临床资料。最终入组45例患者,其中男性20例,女性25例,年龄(71.3±8.2)岁。45例患者均行PTCD、腹腔镜胆总管探查一期缝合。分析PTCD至腹腔镜胆总管探查一期缝合时间间隔,入院时和PTCD后白细胞计数、总胆红素、丙氨酸氨基转移酶,腹腔镜胆总管探查一期缝合手术时间、术中出血量,术后腹腔引流管留置时间、术后住院时间、术后并发症(胆漏、出血等)等。结果45例患者入院时血清总胆红素为(143.2±32.1)μmol/L、丙氨酸氨基转移酶为(173.6±23.4)U/L、白细胞计数为(16.3±2.9)×10^(9)/L,PTCD后分别为(100.5±21.4)μmol/L、(103.5±12.7)U/L、(8.6±1.7)×10^(9)/L。PTCD至腹腔镜胆总管探查一期缝合时间间隔为(4.3±1.1)d,腹腔镜胆总管探查一期缝合手术时间为(123.4±20.5)min,术中出血量为(32.6±8.7)ml。45例患者术后住院时间为(6.8±1.6)d,术后腹腔引流管留置时间为(4.5±1.3)d,发生术后并发症7例(15.6%),其中胆漏4例(8.9%)、剑突下切口感染1例(2.2%)、胆囊窝积液伴感染2例(4.4%)。结论PTCD序贯腹腔镜胆总管探查一期缝合是胆总管结石合并中重度急性胆管炎一种安全、有效、微创的治疗方式,PTCD后1周内行腹腔镜胆总管探查一期缝合安全可行。ObjectiveTo study the clinical efficacy of percutaneous transhepatic cholangial drainage(PTCD)and primary closure of common bile duct after laparoscopic common bile duct exploration(LCBDE)in treatment of choledocholithiasis complicated with moderate and severe cholangitis.MethodsThe clinical data of 127 patients with choledocholithiasis complicated with acute cholangitis admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to August 2023 were retrospectively analyzed.Finally,45 patients were enrolled,including 20 males and 25 females,aged(71.3±8.2)years.All 45 patients were treated with sequential PTCD and primary closure of common bile duct after LCBDE.The interval from PTCD to primary closure,white blood cell count,total bilirubin,alanine transaminase before and after PTCD,operation time of primary closure,intraoperative blood loss,postoperative retention time of abdominal drainage tube,postoperative hospitalization time,postoperative complications(bile leakage,bleeding,etc.)were analyzed.ResultsThe serum total bilirubin,alanine transaminase and white blood cell count of 45 patients were(143.2±32.1)μmol/L,(173.6±23.4)U/L,(16.3±2.9)×10^(9)/L at admission,and(100.5±21.4)μmol/L,(103.5±12.7)U/L,(8.6±1.7)×10^(9)/L after PTCD,respectively.The interval between PTCD and primary closure of common bile duct after LCBDE was(4.3±1.1)d,the operative time of primary closure was(123.4±20.5)min,the amount of intraoperative blood loss was(32.6±8.7)ml.The postoperative hospitalization time was(6.8±1.6)d,and the postoperative retention time of abdominal drainage tube was(4.5±1.3)d,and postoperative complications occurred in 7 cases(15.6%),including biliary leakage in 4 cases(8.9%),subxiphoid incision infection in 1 case(2.2%),and effusion in gallbladder fossa with infection in 2 cases(4.4%).ConclusionThe sequential application of PTCD and primary closure of common bile duct after LCBDE in treatment of choledocholithiasis complicated with moderate and severe cholangitis is a safe,e

关 键 词：胆总管结石病 胆管炎 胆总管探查 经皮肝穿刺胆道引流 一期缝合 

分 类 号：R657.4[医药卫生—外科学]