腹腔镜与开腹胆总管探查术144例对比研究

Comparative study of laparoscopic common bile duct exploration and open surgery in 144 cases

目的探讨胆囊结石合并胆总管结石行胆总管探查术的术式选择。方法回顾性分析144例胆囊结石合并胆总管结石患者行腹腔镜与开腹胆总管探查术的临床资料。根据手术方式分为腔镜组(n=78)和开腹组(n=66)。结果腔镜组一期缝合39例,T管引流32例,经胆囊管探查2例,中转开腹5例;术后胆漏7例,胆管炎4例,残余结石2例,肠穿孔1例,MODS 1例,电解质紊乱5例,伤口感染2例。开腹组术后胆漏合并胸、腹腔积液1例,胆管炎1例,残余结石2例,术后出血再次手术1例,电解质紊乱4例,伤口感染4例,肝肾功能不全2例,死亡1例。两组在术后并发症发生率方面比较差别无统计学意义(P>0.05)。结论与开腹手术比较,腹腔镜胆总管探查取石术具有微创、术中失血少、术后恢复快、术后住院时间短等优点,但尚不能完全替代传统开腹手术。

Objective To evaluate the choice of operation methods in treatment of gallstone with common bile duct stones. Methods The clinical data of 144 cases of gallstone and common bile duct stones who underwent laparoscopic common bile duct exploration or open surgery was retrospectively analyzed. According to the way of treatment, cases were divided into two groups： laparoscope group （n=78） and laparotomy group （n=66）. Results Laparoscopic common bile duct exploration was performed in 78 cases, of whom 39 cases had primary closure and 32 cases had T-tube drainage, two cases were treated through transcystic approach and 5 cases were converted to laparotomy. The postoperative complications of laparotomy group consisted of biliary fistula （n=7）, cholangitis （n=4）, residual bile duct calculi （n=2）, intestinal perforation （n= 1）, multiple organ dysfunction syndrome （n=l）, electrolytes disorder （n=5） and incision infection （n=2）. While that of laparotomy group （n=66） consisted of biliary fistula merger pleural effusion and peritoneal effusion （n= 1）, cholangitis （n= 1）, residual bile duct calculi （n =2）, reoperation for postoperative bleeding （n=1）, electrolytes disorder （n=4）, incision infection （n=4）, hepatic insufficiency combined with renal dysfunction （n=2） and 1 death. There was no significant difference in the incidence of postoperative complications between the two groups （P〉0.05）. Conclusion Laparoscopic common bile duct exploration has the advantage of minimally invasive, less blood loss, faster recovery and shorter postop- erative hospital stay, but it still cannot completely replace the open surgery.