腹腔镜下经胆囊管胆总管探查术与胆总管探查并一期缝合术治疗胆总管结石的对比研究

目的:比较腹腔镜下经胆囊管胆总管探查术(LTCBDE)与经胆总管探查(LCBDE)+胆道一期缝合术治疗胆总管结石的效果。方法:回顾性分析2013年1月—2015年12月期间应用微创手术治疗的104例胆总管结石的患者临床资料,其中50例行LTCBDE(LTCBDE组)与54例行LCBDE+胆道一期缝合术(LCBDE+一期缝合组),比较两组的相关临床指标。结果:与LCBDE+一期缝合组比较,LTCBDE组手术时间(91.7 min vs.110.9 min)、术中出血量(15.5 mL vs.17.4 mL)、术后引流量(28.4 mL vs.44.6 mL)、带管时间(7.8 d vs.9.7 d)、住院时间(8.8d vs.10.6d)均明显减少(均P0.05);LTCBDE组术后胆汁漏的发生率明显低于LCBDE+一期缝合组(2.0%vs.13.0%,P=0.036),其他并发症的发生率两组无统计学差异(均P0.05)。结论:LTCBDE治疗胆总管结石安全可靠的,且较LCBDE+胆道一期缝合术更符合微创的目的,在两种术式的适应证均满足的情况下,可优先考虑。

Comparison of laparoscopic transcystic common bile duct exploration and laparoscopic common bile duct exploration with primary suture for common bile duct stones

Objective: To compare the effects between laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE) with primary biliary suture in treatment of common bile duct stones. Methods: The clinical data of 104 patients undergoing minimally invasive therapy for common bile duct stones from January 2013 to December 2015 were retrospectively analyzed. Of the patients, 50 cases received LTCBDE treatment (LTCBDE group) and 54 cases had LCBDE plus primary biliary suture (LCBDE plus primary suture group). The main clinical variable between the two groups were compared. Results: In LCBDE compared with LCBDE plus primary suture group, the operative time (91.7 min vs. 110.9 min), intraoperative blood loss (15.5 mL vs. 17.4 mL), amount of postoperative drainage (28.4 mL vs. 44.6 mL), tube retention time (7.8 d vs. 9.7 d) and length of hospital stay (8.8 d vs. 10.6 d) were all significantly reduced (all P<0.05). The incidence of postoperative bile leakage in LTCBDE group was significantly lower than that in LCBDE plus primary suture group (2.0% vs. 13.0%, P=0.036), while no significant difference was noted in incidence of other postoperative complications between the two groups (all P>0.05). Conclusion: In treatment of common bile duct stones, LCBDE is safe and reliable, and more accurately reflect the requirements of minimal invasiveness than LCBDE plus primary biliary suture. So it is recommended to be the first choice for the conditions with indications for both procedures.