经胆囊管腹腔镜胆道探查术治疗胆总管结石的临床研究

目的:比较分析腹腔镜下经胆囊管和经胆总管切开T管引流两种方法胆道镜取石治疗胆囊结石继发胆总管结石的疗效,以评价经胆囊管腹腔镜胆道探查术治疗胆总管结石的临床价值。方法:2001年3月至2003年3月按胆道探查途径不同将28例胆石症患者分为胆囊管组(n=8)和胆总管切开组(n=20)。患者经B超和术中胆道造影或加内窥镜逆行胆管造影(ERC)确诊。观察两组病例的术后肛门排气时间、腹腔引流时间、术后住院日、住院费用及手术并发症的发生情况,术后对患者进行全程跟踪随访。结果:胆总管切开组肛门排气时间、腹腔引流时间、术后住院日、住院费用明显长于或高于胆囊管组(P>0.05)。胆囊管组发生手术并发症1例(12.5%);胆总管切开组5例(25.0%),其中胆道并发症4例(20.0%),需要再次微创处理2例(10.0%),需再次手术治疗的严重并发症2例(10.0%);手术并发症发生率胆总管切开组明显高于胆囊管组(P<0.05)。随访两组患者均无胆管狭窄、急性胆管炎及急性胰腺炎发生和结石复发。结论:经胆囊管途径的腹腔镜胆道探查术充分体现了微创外科技术的优点,适于胆囊结石继发胆总管结石患者,其疗效优于胆总管切开T管引流途径的腹腔镜胆道探查术。

A clinical study on laparoscopic transcystic bile duct exploration for common bile duct stones

Objective:To evaluate the effect of laparoscopic transcystic bile duct exploration for common bile duct stones. Methods: From March 2001 to March 2003,28 patients with cholecystolithiasis and secondary common bile duct stones were treated with laparoscopic bile duct exploration. The patients were divided into two groups: transcystic group(n=8)and choledochotomy group(n=20).All the data were recorded and studied retrospectively,and the patients were followed up after being discharged.Results:Compared with choledochotomy group,transcystic group had less quantity of postoperative bile drainage and hospital costs,shorter GI function recovery and postoperative hospital stay. The incidence of postoperative complications in transcystic group was 12.5%(1/8),while in choledochotomy group it was 25.0%(5/20), and four of the latter one had biliary complications,two were reoperated. There were no stenosis of bile duct,acute cholangitis,acute pancreatitis and bile stone recurrence in two groups.Conclusions: The transcystic method in laparoscopic biliary tract explaration can avoid the deficiency of choledochotomy,and it is feasible and safe with lower complications in treating common bile duct stones.