对腹腔镜胆总管探查一期缝合术的再认识

目的探究腹腔镜胆总管探查一期缝合术的适应证及临床疗效。方法回顾性分析2014年1月至2018年12月292例接受腹腔镜联合胆道镜胆总管探查一期缝合手术患者的临床资料,术后定期随访。采用SPSS 24.0软件进行数据分析。计量资料非正态分布数据,采用中位数M(P25,P75)表示,组间比较采用Kruskal-Wallis H检验,采用Bonferroni法校正显著性水平的事后两两比较。计数资料组间比较采用χ^2检验。P<0.05为差异有统计学意义。结果本组292例患者,手术例数呈逐年增加趋势。其中,胆总管结石患者287例,胆总管占位1例,胆总管阴性探查4例。手术时间为85(70,100)min,术中出血量为20(10,50)ml。术后腹腔引流管拔管时间为3(2,3)d,术后住院日为4(3,5)d。术后并发症9例(3.08%),其中胆漏6例、腹腔感染1例、低钾1例、肺部感染1例。胆漏患者中,1例行内镜治疗,其余5例均于术后2~4 d内自愈。术后中位随访17(0.5~58.2)个月,3例患者出现胆总管结石复发,行内镜治疗。结论腹腔镜联合胆道镜胆总管探查一期缝合术安全可行,手术创伤小,术后恢复快。胆总管结石取净、管腔通畅及阴性探查患者可行一期缝合,治疗指征得以扩大。

Further recognition of laparoscopic common bile duct exploration with a primary suture

Objective To explore the indication and clinical efficacy of laparoscopic common bile duct exploration(LCBDE)with a primary suture.Methods This retrospective study of clinical data of patients receiving LCBDE with a primary suture was conducted from Jan 2014 to Dec 2018,with a regular follow-up of patient after surgery.SPSS 24.0 software were used for statistical analysis.Measurement data with non-normal distribution were described as median M(P25,P75),and comparison between groups was analyzed by using Kruskal-Wallis H Test,followed by the Bonferroni adjustment.Comparison of count data between groups were analyzed by using the chi square test.A P value of P<0.05 was considered as significant difference.Results A total of 292 patients were enrolled into this study.The number of patients increased annually.Among them,287 patients were diagnosed with choledocholithiasis,1 patient with common bile duct neoplasm and 4 patients with negative exploration.The median operation time was 85(70,100)min,the median blood loss was 20(10,50)ml.The abdominal drainage tube was removed on 3(2,3)th day post operation.The median postoperative hospital stay was 4(3,5)days.9(3.08%)patients developed postoperative complications including 6 biliary leakage,1 abdominal infection,1 hypokalemia and 1 pulmanary infection.Among the 6 patients with biliary leakage,1 was treated with ERCP and the others received self-healing after 2-4 days postoperatively.After a median follow-up of 17(0.5-58.2)months,3 patients developed common bile duct stone recurrence then were treated with ERCP.Conclusion LCBDE with a primary suture is safe and reliable and is characterized with fast recovery and minimal invasion.Its indication might include patients with unobstructed lumen,no residual bile duct stone after exploration or negative exploration.