腹腔镜下胆总管一期缝合手术的临床研究和经验总结

目的研究腹腔镜胆总管一期缝合术治疗胆总管结石患者的临床治疗效果和经验总结。方法回顾性分析2013年~2017年在我院施行腹腔镜胆总管一期缝合术的患者41例(一期缝合组)的临床资料及手术资料,同时回顾性分析同期在我院行腹腔镜胆总管切开取石,T管引流术的患者43例(T管引流组)的临床资料及手术资料。结果一期缝合组在住院天数,排气时间少于T管引流组,其差异有统计学意义(P0.05),两组在手术时间,出血量,胆漏率,伤口感染率,胆道狭窄率等方面差异无统计学意义(P0.05)。一期缝合组和T管引流组分别有1例和2例胆瘘发生,均经过保守治疗痊愈。结论在严格把握适应症的基础上,腹腔镜胆总管一期缝合术治疗胆总管结石患者是安全有效的,但应该由有经验的医生操作。

Clinical study of laparoscopic primary suture of common bile duct

［Abstract］ Objective To study the clinical effect of laparoscopic common bile duct exploration （LCBDE） with primary closure in the treatment of choledocholithiasis and summarize experience. Methods A retrospective analysis of 41 patients from 2013 to 2017 in our hospital underwent LCBDE with primary closure（LCBDE with primary closure group）were analyzed. Another 43 patients during the same period received laparotomy choledocholithotomy with T tube drainage were assigned to control group （T tube group）. Results In LCBDE with primary closure group, hospitalization days and exhaust time were less than those in T?tube group, the difference was statistically significant（P<0.05）. There was no statistically significant difference in operative time, bleeding volume, bile leakage, wound infection rate and biliary tract stenosis between two groups（P>0.05）. Bile leakage occurred in one case in LCBDE with primary closure group and two cases in T?tube group, which were all cured by conservative treatment. Conclusion On the basis of strict assurance of indications, laparoscopic common bile duct primary suture is safe and effective for patients with common bile duct stones. But it should be operated by an experienced doctor.