腹腔镜联合胆道镜经胆囊管胆道探查日间手术可行性探讨

目的探讨腹腔镜术中联合胆道镜经胆囊管胆道探查(laparoscopic transcystic common bill duct exploration,LTCBDE)并取石术实施日间手术的可行性。方法回顾性分析2016年2月至2017年5月在首都医科大学附属北京友谊医院由同一组手术团队完成的39例择期行LTCBDE治疗胆囊结石合并胆总管结石的临床资料。所有患者均在门诊完成术前检查和术前评估;患者于手术当日入院,术后24 h内离院回家;回家12h内电话随访,术后第7日门诊随访。结果 39例患者均顺利完成LTCBDE,无胆总管切开及中转开腹,术后所有患者均于入院24 h内出院,其中手术当天出院37例,过夜观察次日晨出院2例。手术时间45~113 min,平均手术时间(72.5±24.8)min;39例患者术后6 h均进流食,术后腹部切口疼痛23例,恶心、呕吐12例,伤口少量渗血2例,给予常规对症处理后缓解。住院费用平均(9 134.6±824.4)元。随访至今无腹部不适症状。结论严格掌握适应证,选择性施行LTCBDE的日间手术是安全可行的,适合有条件的大型医院开展。

The feasibility of day-case laparoscopy combined with trancystic common bile duct exploration

Objective To investigate the feasibility of laparoscopy combined with transcystic common bile duct exploration in ambulatory surgery. Methods Exploratory research was performed on the clinical outcome of 39 patients by LTCBDE between Feb. 2016 to May 2017 in Beijing Friendship Hospital. Results Thirty-nine LTCBDE were perfomed. No conversion to open surgery or incision of common bile duct was performed. All patients were discharged during 24 h after operation. Of which 37 cases were discharged on the day of surgery, 2 cases were discharged the following morning. The operation duration was 45~113 minutes, the average opera-tion duration was (72.5±24.8) min. Thirty-nine patients were given semi-liquid diet 6 h after the operation. Pain at abdominal incision was described in 23 cases. Postoperative nausea and vomiting occurred in 12 cases. Wound bleeding happened in 2 cases, and treated with routine treatment. The average hospitalization expenses was (9134.6±824.4) yuan. Conclusion Day-case LTCBDE is safe, and feasible. It is suitable for large experienced hos-pitals.