腹腔镜下经胆囊管切开胆总管取石并胆道一期缝合的临床研究

Clinical research on laparoscopic transcystic common bile duct exploration and primary closure of common bile duct

目的探讨腹腔镜下经胆囊管切开胆总管取石胆道一期缝合术治疗肝外胆管结石的可行性。方法按照纳入标准和排除标准,纳入腹腔镜微创手术治疗肝外胆管结石45例患者,其中经胆囊管切开胆总管取石胆道一期缝合患者23例(实验组),直接经胆总管切开取石胆道一期缝合患者22例(对照组),比较两组分离切开时间、手术时间、一期缝合时间、胆总管切开长度、术中出血量、术后引流量、住院时间,以及相关并发症(胆漏、胆道狭窄、残余结石、急性胰腺炎等)的发生率、胆道镜探查成功率。结果与对照组比较,实验组不增加术中出血量(P=0.10),胆总管切口长度短(P=0),术后引流量少(P=0),分离切开时间长(P=0),一期缝合时间短(P=0)。两组总的手术时间、住院时间差别无统计学意义(P>0.05)。实验组不增加胆道狭窄、残余结石、急性胰腺炎及胆漏的发生(P>0.05)。在实验组中1例患者胆道镜探查失败,对照组中全部患者胆道镜探查顺利。结论腹腔镜下经胆囊管切开胆总管取石胆道一期缝合术治疗肝外胆管结石是安全可行的。

Objective To explore the feasibility of laparoscopic trancystic common bile duct exploration （LTCBDE） and primary closure of common bile duct. Methods According to the inclusion and exclusion criteria, a total of 45 patients underwent laparoscopic common bile duct exploration with primary duct closure, among which 23 patients experienced cystic duct incision as study group, while 22 patients accepted common bile duct incision as control group. The length of common bile duct mobilization and incision, operation time, the time of primary closure, the length of common bile duct incision, the amount of bleeding, postoperative peritoneal drainage, the hospitalization duration, the incidences of biliary related complications （postoperative bile leakage, biliary strictures, residual stone, acute pancreatitis ）, the success rate of choledochoscope exploration were compared in the two groups. Results The length of common bile duct incision and peritoneal drainage and the time of primary closure were decreased in study group compared with those in control group （P = 0）, but the length of common bile duct mobilization and incision was increased. There was no significant difference in the amount of bleeding （P = 0.10）, the time of operation and postoperative hospitalizationduration （P 〉 0.05） between study group and control group. The incidences of biliary related complications （residual stone, acute pancreatitis, biliary strictures bile leakage） between study group and control group were found no significant difference （P 〉 0.05）. One cases of patients in the study group suffered failure in bile duct exploration, all patients in the control group finished bile duct exploration smoothly. Conclusion LTCBDE with primary closure of common bile duct is safer and feasible method in the treatment of extrahepatic bile duct stone.