腹腔镜胆总管探查输尿管导管外引流治疗胃癌术后胆囊结石合并胆总管结石的疗效观察

Clinical efficacy observation of laparoscopic common bile duct exploration and ureteral catheter drainage in the treatment of cholecystocholedochlithiasis among the postoperative patients with gastric cancer

目的:探讨腹腔镜胆总管探查术经胆囊管输尿管导管外引流治疗胃癌术后胆囊结石合并胆总管结石的临床疗效。方法:回顾性分析2014年1月至2021年10月间收治的45例胃癌术后胆囊结石合并胆总管结石患者行腹腔镜胆总管探查术,其中20例行胆总管一期缝合经胆囊管输尿管导管引流(细管组),25例行T管引流(T管组),比较相关临床资料。结果:45例均顺利完成手术,两组术中出血量、手术时间、胆总管残余结石发生率差异均无统计学意义(P>0.05),细管组引流管拔除时间及术后住院时间均短于T管组(P<0.05)、胆漏发生率低于T管组(P<0.05)。结论:对于胃癌术后胆囊结石合并胆总管结石的患者,在取尽结石的前提下,行腹腔镜胆总管探查一期缝合经胆囊管输尿管导管引流是安全有效的,可减少术后胆漏发生的风险。

Objective:To explore the clinical efficacy of laparoscopic common bile duct exploration and ureteral catheter drainage in the treatment of cholecystocholedocholithiasis among the postoperative patients with gastric cancer.Methods:Clinical data of 45 patients who suffered from cholecystocholedocholithiasis after gastric cancer operation,and underwent laparoscopic common bile duct exploration were analyzed.20 cases were treated with fureteral catheter intemal drainage and prirnary suture of common bile duct exploration(tubule group),while another 25 cases were treated with T-tube drainage(T-group).Results:All were successfully operated by laparoscope.There was no significant difference in blood loss,operation time and residual stone rate in patients with choledocholithiasis between the two groups(P>0.05).The drainage tube removal time,postoperative hospitalization time and the incidence rate of biliary leakage in the tubule group were significantly less than those in the T-group(P<0.05).Conclusion:For the postoperative gastric cancer patients,the combined treatment with primary suture of laparoscopic common bile duct exploration and ureteral catheter internal drainage is safe and effective,which can reduce the risk of postoperative bile leakage.