腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的临床应用

Clinical application of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy

目的 探讨腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的安全性及疗效.方法 回顾性研究2011 年1 月至2014 年12 月在潮州市中心医院接受诊治的178 例胆总管结石患者临床资料.其中男83 例,女95 例;平均年龄（46±3）岁.所有患者均签署知情同意书,符合医学伦理学规定.所有患者均行腹腔镜联合胆道镜胆总管切开取石术,根据胆总管切口处理方式不同将患者分为一期缝合组和T 管引流组,取石后一期缝合组采用胆总管一期缝合;T 管引流组采用“T”管引流.观察两组患者手术时间、排气时间、住院时间、住院费用、术后并发症等指标.两组患者观察指标比较采用t 检验或χ2 检验. 结果 两组患者均手术顺利.一期缝合组患者的手术时间、排气时间、住院时间、住院费用分别为（119±18）min、（25±7）h、（6±1）d、（1.2±0.2）万元,与T 管引流组的（136±20）min、（38±8）h、（10±1）d、（1.5±0.2）万元相比,差异有统计学意义（t=2.38,5.00,7.21,3.87;P〈0.05）.一期缝合组患者术后并发症发生率为8%（3/37）明显低于T 管引流组的12%（17/141）（ χ^2=3.28,P〈0.05）.一期缝合组术后发生胆漏3 例,切口感染1 例;T 管引流组胆漏1 例,胆囊窝积液5 例,切口感染11 例,粘连性肠梗阻10 例,所有患者均经对症处理后治愈. 结论 腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合术安全、有效,具有恢复快,费用低、并发症发生率低等优势.

ObjectiveTo investigate the safety and curative effect of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy.MethodsClinical data of 178 patients with choledocholithiasis diagnosed and treated in Chaozhou Central Hospital between January 2011 and December 2014 were retrospectively studied. Among the 178 patients, 83 were males and 95 were females with the average age of (46±3) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent laparoscopic and choledochoscopic choledocholithotomy and were divided into the primary closure group and the T-tube drainage group according to the different treatment for the incision of choledocholithotomy. The patients in the primary closure group underwent primary closure of common bile duct and the patients in the T-tube drainage group received T-tube drainage following choledocholithotomy. The operation duration, exhaust&nbsp;time, length of stay, hospitalization expenses and postoperative complication of two groups were observed. The observation indexes of two groups were compared usingt test or Chi-square test.ResultsThe patients in two groups completed choledocholithotomy successfully. The operation duration, exhaust time, length of stay, hospitalization expenses were respectively (119±18) min, (25±7) h, (6±1) d, (12 000±2 000) yuan in the primary closure group, and were respectively (136±20) min, (38±8) h, (10±1) d, (15 000±2 000) yuan in the T-tube drainage group. And significant difference was observed (t=2.38, 5.00, 7.21, 3.87;P<0.05). The incidence of postoprative complication in the primary closure group was 8%(3/37), which was signiifcantly lower than 12%(17/141) in the T-tube drainage geoup (χ2=3.28,P<0.05). In the primary closure group, 3 patients developed bile leakage and 1 developed incision infection. In the T-tube drainage group, 1 patient developed bile leakage, 5 gallbladder fossa hydrops, 11 incision infection and 10 adhesive intestinal obstruction. All patients recovered after symptomatic treatments.ConclusionCommon bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy is safe, effective and has the advantages of quick recovery, low costs and low complication incidence.