腹腔镜再次胆道手术治疗胆总管结石

Relaparoscopic common bile duct exploration for management of choledocholithiasis

目的探讨腹腔镜再次胆道手术治疗胆总管结石的安全性和效果。方法选择性地对我院收治的50例有腹腔镜胆囊切除术／开腹胆囊切除术／腹腔镜胆总管探查取石术／开腹胆总管探查取石术（LC／OC／LCBDE／OCBDE）胆道手术史的胆总管结石患者随机分成A、B两组，分别采用腹腔镜手术和开腹手术治疗。比较两组手术时间、胃肠道恢复时间、住院时间、住院总费用及术后并发症等的差异。结果两组患者手术时间、肝功能指标、胆漏发生率及住院费用无显著差异（P〉0．05）。腹腔镜手术组较开腹组术中失血量少[分别为（58．3±24．2）ml和（108．6±35．7）ml，P〈0．05]、术后住院时间缩短[分别为（7．1±1．5）d和（12．4±4．3）d，P〈0．05]、胃肠道恢复时间缩短[分别为（26．3±3．6）h和（58．2±6．3）h，P〈0．05]、术后镇痛减少（分别为7／25和17／25，P〈0．05）、伤口感染率下降（分别为1／25和6／25，P〈0．05）。结论具有丰富经验的腹腔镜专科医师开展腹腔镜胆道再次探查术安全、有效、可行，有推广价值。

Objective To investigate the efficacy of relaparoscopic common bile duct exploration in eholedocholithiasis. Methods 50 patients who underwent LC/OC/LCBDE/OCBDE for biliary surgery with choledocholithiasis were randomized into two groups： Group A （n = 25 ） laparoscopic approach and Group B （ n = 25 ） open approach. The operation time, hospital stay, cost of hospitalization and postoperative compli- cations were compared. Results There was no significant difference in the operation time, liver functional index, postoperative bile leakage rate and cost of hospitalization between the two groups. The postoperative hospital stay in group A was shorter than that in group B （7.1 ± 1.5 vs 12. 4 ±4. 3 days, P 〈0. 05）, as was the volume of intraoperative blood loss （58.3 ± 24. 2 ml vs 108.6 ±35.7 ml, P 〈 0. 05 ）, recovery of gastrointestinal function （26. 3 ±3.6 vs 58.2 ±6. 3 hours, P 〈 0. 05 ）, postoperative analgesia （ 7/25 vs 17/25, P〈O. 05） and wound infection rate （1/25 vs 6/25, P 〈0.05）. Conclusions Relaparoscopic common bile duct exploration for recurrent eholedoeholithiasis appeared to be a safe, feasible, and efficacious procedure when carried out by expert laparoseopic surgeons. The procedure is worth promoting.