腹腔镜下胆囊管开口微切开与胆总管切开治疗胆管结石的对照研究

Controlled study of laparoscopic transcystic common bile duct exploration by micro incision the cystic duct

目的探讨腹腔镜下经胆囊管开口微切开胆管并一期缝合胆管术(LTCBDE)与腹腔镜下胆总管切开取石T管引流术(LCTD)治疗胆囊并胆管结石的疗效及应用价值。方法将130例拟行手术治疗的胆囊并胆管结石患者分为LTCBDE组65例、LCTD组65例,比较两组手术成功率、手术时间、术后肠功能恢复、术后止痛、切开感染、住院时间、住院费用和残留结石发生率等指标。结果 LTCBDE组与LCTD组相比,在手术时间、术后胆瘘、住院时间及住院费用等方面差异有显著性(P<0.05);而在手术成功率、肠功能恢复时间、术后止痛及残余结石等方面差异无显著性(P>0.05)。结论经胆囊管开口微切开胆总管取石手术具有手术时间短、术式简单易行、不需要留置T管、术后胆漏少且易控制的特点,是胆囊并胆管结石很好的微创治疗方法。

[Objective] To explore the efficacy and application value of laparoscopic transcystic common bile duct exploration （LTCBDE） in treatment of gallbladder and bile duct stones compared with 1aparoscopic choledocholithotomy plus T-tube drainage （LCTD）. [Methods] 130 patients of planned operation treatment of gallbladder and bile duct stones were divided into 65 cases in LTCBDE group, 65 cases in LCTD group. Comparison of two groups of the success rate of operation, operation time, and recovery of intestinal function after surgery, postoperative pain, incision infection, hospitalization time, hospital costs and the incidence of residual gallstones was conducted. [Results] LTCBDE group compared with LCTD group, the operation time, postoperative biliary fistula, hospitalization time and hospital costs were statistically significant （P 0.05）. [Conclusions] Laparoscopic transcystic common bile duct exploration by micro incision of the cystic duct is simple, safe and effective, little injury, doesn＇t need T indwelling tube in treatment of gallbladder and bile duct stones.