腹腔镜胆道探查胆总管一期缝合术治疗胆管结石的疗效分析

目的探讨腹腔镜下胆道探查术、胆总管一期缝合术的临床疗效与可行性。方法2014年2月至2017年2月收集贵州医科大学附属医院106例胆总管结石病人,男性44例、女性62例,年龄18~75岁,平均(46.5±15.7)岁。106例胆总管结石病人,伴或不伴胆囊结石与肝内胆管结石,其中腹腔镜下胆道探查胆总管一期缝合术67例,腹腔镜下胆道探查T管引流术39例,对两组病例手术适应证、手术时间、术后恢复情况、并发症等进行比较。结果胆总管一期缝合组的手术时间、术后住院天数、腹腔引流管放置时间分别为(72.8±21.0)min、(2.8±1.9)d和(5.5±2.3)d,优于T管引流术组的(95.5±26.5)min、(5.7±1.4)d和(8.1±2.6)d(均P0.05),术后肛门排气时间两组分别为(1.9±0.8)d和(2.1±0.5)d、差异无统计学意义;两组均无肝衰竭、腹腔感染、胆管残余结石、胆道出血及穿孔,胆漏发生率T管引流术组(3例)高于胆总管一期缝合组(0例)(P0.05)。结论腹腔镜胆道探查胆总管一期缝合术治疗胆管结石是安全、可行的,病人明显受益,值得临床推广应用。

The effect of laparoscopic bile duct exploration and primary anastomosis on the treatment of bile duct stones

Objective To investigate the therapeutic effects of laparoscopic bile duct exploration and primary anastomosis on the treatment of bile duct stones.Methods There were 106 cases of common bile duct stones with or without gallstones and intrahepatic stones.Sixty-seven cases underwent laparoscopic bile duct exploration and primary anastomosis,and 39 cases were given T-tube drainage in laparoscopic choledochotomy.The perioperative complications and postoperative recovery of the surgical methods were evaluated.Results The primary duct closure group had shorter operative time,quicker postoperative intestinal exhaust time and shorter abdominal cavity drainage tube placement time than the T-tube drainage group (P<0.05).There was no significant difference in the incidence of hepatic failure,intra-abdominal infection,residual gallstone,biliary tract bleeding and perforation between two groups.The incidence of biliary leakage was higher in the T-tube drainage group (3 cases) than in the primary duct closure group (0).Conclusions The laparoscopic bile duct exploration and primary anastomosis on the treatment of bile duct stones is safe,feasible,and suitable for clinical practice.