腹腔镜胆总管切开探查取石一期缝合的安全性与疗效:附128例分析  

Safety and efficacy of primary duct closure after laparoscopic common bile duct exploration:analysis of 128 cases

作　　者：冯嘉楠 蔡磊[1] 何国林[1] 付顺军 张成[1] 冯周彬 温耀鸿 谭洪坤 潘明新 Feng Jianan;Cai Lei;He Guolin;Fu Shunjun;Zhang Cheng;Feng Zhoubin;Wen Yaohong;Tan Hongkun;Pan Mingxin(Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University,Guangzhou 510260,China)

机构地区：[1]南方医科大学珠江医院肝胆外二科,广州510260

出　　处：《中华肝脏外科手术学电子杂志》2024年第4期543-550,共8页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省卫生健康适宜技术推广项目(202303171028352542)

摘　　要：目的探讨腹腔镜胆总管切开探查取石后一期缝合的安全性与疗效。方法回顾性分析2020年2月至2023年2月南方医科大学珠江医院收治的128例胆总管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男84例,女44例;年龄21~89岁,中位年龄59岁。患者均采用腹腔镜胆总管切开探查取石术,根据胆总管闭合方法的不同,将患者分为一期缝合组(PDC组,60例)和T管引流组(TTD组,68例)。观察两组围手术期肝功能及并发症发生情况。两组肝功能比较采用独立样本t检验或非参数检验等,并发症发生率比较采用χ^(2)检验或Fisher确切概率法。结果PDC组术后3 d的AST、ALT平均为(25.6±1.5)、(52.5±5.4)U/L,明显低于TTD组的(38.8±4.6)、(97.1±15.5)U/L(t=-2.752,-2.197;P<0.05)。PDC组手术时间、术后肛门排气时间、术后住院时间、住院费用分别为(134±5)min、(36.6±2.2)h、(4.47±0.14)d、(4.70±0.15)万元,明显低于TTD组的(163±7)min、(53.6±2.2)h、(6.15±0.35)d、(5.78±0.17)万元(t=-3.029,-5.307,-3.573,-5.171;P<0.05)。两组总体并发症发生率分别为29%(20/68)、15%(9/60),差异无统计学意义(χ^(2)=3.778,P>0.05)。TTD组残余结石6例,PDC组无残余结石发生,差异有统计学意义(P=0.018)。两组均未观察到死亡及术后胆道狭窄发生。结论相比T管引流,腹腔镜胆总管切开探查取石术中采用PDC能使患者手术时间更短、术后恢复更快、治疗周期更短、医疗开销更少、结石的一次清除率更高,且不会增加总体并发症发生率,是一种安全、高效的微创术式。Objective To evaluate the safety and efficacy of primary duct closure after laparoscopic common bile duct exploration(LCBDE).Methods Clinical data of 128 patients with common bile duct stones admitted to Zhujiang Hospital of Southern Medical University from February 2020 to February 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,84 patients were male and 44 female,aged from 21 to 89 years with the median of 59 years.All patients were treated with LCBDE.According to different closure methods of common bile duct,all patients were divided into primary duct closure group(PDC group,n=60)and T-tube drainage group(TTD group,n=68).Perioperative liver function and incidence of complications were observed between two groups.Liver function between two groups was compared by independent sample t test or nonparametric test.The incidence of complications was compared by Chi-square test or Fisher's exact test.Results In the PDC group,the average AST and ALT levels at postoperative 3 dwere(25.6±1.5)and(52.5±5.4)U/L,significantly lower than(38.8±4.6)and(97.1±15.5)U/L in the TTD group(t=-2.752,-2.197;P<0.05).In the PDC group,the operation time,time to first flatus,length of postoperative hospital stay and hospitalization expense were respectively(134±5)min,(36.6±2.2)h,(4.47±0.14)d and(4.70±0.15)×104 Yuan,significantly less than(163±7)min,(53.6±2.2)h,(6.15±0.35)dand(5.78±0.17)×104 Yuan in the TTD group(t=-3.029,-5.307,-3.573,-5.171;P<0.05).The overall incidence of complications in two groups was 29%(20/68)and 15%(9/60)respectively,and the difference was not statistically significant(χ^(2)=3.778,P>0.05).In the TTD group,6 patients had residual stones,whereas no case had residual stones in the PDC group,and the difference was statistically significant(P=0.018).No death or postoperative biliary stricture was observed in two groups.Conclusions Compared with TTD,PDC in LCBDE can shorten operation time,accelerate postop

关 键 词：胆总管结石 腹腔镜胆总管探查术 一期缝合 T管引流 残余结石 加速康复外科 

分 类 号：R657.4[医药卫生—外科学]