腹腔镜联合胆道镜胆管可控式自脱支架治疗胆总管结石合并胆管炎的临床观察

目的:比较双镜(腹腔镜+胆道镜)联合胆总管探查取石胆管可控式自脱支架置入一期缝合与T管引流治疗胆总管结石合并胆管炎的临床疗效;探讨其可行性与安全性。方法:回顾分析2015年2月至2018年8月因胆囊结石、胆总管结石合并胆管炎行双镜联合胆囊切除、胆总管探查取石术的84例患者的临床资料,按术中胆总管引流方式分为可控式自脱支架置入胆管内引流一期缝合组(观察组,n=54)与T管引流组(对照组,n=30),比较两组手术时间、术中出血量、术后肛门排气时间、术后腹腔引流管留置时间、胆漏发生率、住院时间、降钙素原、C反应蛋白、总胆红素、谷丙转氨酶;记录支架管脱落时间与T管拔除时间。结果:84例患者均顺利完成手术;观察组与对照组手术时间(117.9±45.2)min vs.(138.4±52.7)min]、住院时间(8.1±2.2)d vs.(10.6±3.1)d]、术后腹腔引流管留置时间(6.6±1.4)d vs.(8.6±2.6)d]差异有统计学意义(P<0.05)。对照组2例因取石困难术后8周经T管窦道再次取石成功,两组均无术后出血。可控式自脱落支架排出时间为2~6周,拔除T管时间8周。随访12个月,两组均无残余结石、胆管狭窄及支架管残留。结论:腹腔镜联合胆道镜胆总管探查取石胆管可控式自脱支架置入一期缝合术可作为治疗胆总管结石合并胆管炎的常规术式,效果确切,可达到胆道引流的目的,而且避免了留置T管带来的治疗周期长及患者生活不便、水电解质失衡等问题,具有手术创伤小、安全、治疗周期短、操作简便等优势,值得临床推广应用。

Clinical observation of laparoscopic and choledochoscopic bile duct controllable self-detaching stent in the treatment of choledocholithiasis and cholangitis

Objective:To compare the clinical efficacy of laparoscopic combined with choledochoscopic common bile duct exploration with controllable bile duct self-detachment stent first-stage suture and T-tube drainage in the treatment of choledocholithiasis and cholangitis.And its feasibility and safety were discussed.Methods:A retrospective analysis was made on the clinical data of 84 patients who underwent double-endoscopic cholecystectomy and common bile duct exploration for cholecystolithiasis,choledocholithiasis and cholangitis from Feb.2015 to Aug.2018.According to the different drainage methods of common bile duct during operation,54 cases were divided into observation group using controllable self-detachment stent,intra-biliary drainage and one-stage suture,and 30 cases in control group were treated with T tube drainage.The operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative abdominal drainage tube indwelling time,bile leakage,hospitalization time,procalcitonin,C-reactive protein,total bilirubin,alanine aminotransferase were compared between the two groups,the time of stent detachment and T tube removal were recorded.Results:All the 84 operations were successfully completed.The operation time was(117.9±45.2)min in the observation group and(138.4±52.7)min in the control group,the hospital stay was(8.1±2.2)d in the observation group and(10.6±3.1)d in the control group,the time of postoperative abdominal drainage tube indwelling was(6.6±1.4)d in the observation group and(8.6±2.6)d in the control group,there were statistically significant differences between the two groups(P<0.05).Two patients in the control group had difficulty in removing stones,and the calculi were removed through the T-tube sinus tract 8 weeks after surgery.There was no postoperative bleeding in both groups.The discharge time of the controllable self-shedding stent was 2 to 6 weeks,and the T tube removal time was 8 weeks.There were no residual stones,biliary stenosis or residual stent in both groups within 12 months of follow-up.Conclusions:Laparoscopic combined with choledochoscopic common bile duct exploration with bile duct controllable self-detachment stent and primary suture can be used as conventional surgical treatment for choledocholithiasis and cholangitis.This procedure has a definite effect,can achieve the purpose of biliary drainage,and avoids the long treatment cycle,the patient's inconvenience in life,and the imbalance of water and electrolyte caused by the T tube indwelling.It has the advantages of small surgical trauma,safety,short treatment cycle,easy operation and so on,and it is worthy of clinical popularization and application.