腹腔镜胆总管探查术治疗胆总管结石

Laparoscopic common bile duct exploration for choledocholithiasis

目的：探讨腹腔镜胆总管探查术治疗胆总管结石的可行性及临床应用价值。方法回顾性分析2012年1月至2015年12月于中山大学附属汕头医院接受腹腔镜胆总管探查取石术患者的临床资料，收集并分析患者的基本情况、手术资料、术后恢复和随访资料。结果最终纳入376例患者，一期缝合组339例，留置T管引流组37例。与T管引流组相比，一期缝合组的手术时间[（120．0±39．1） min比（165．8±49．9） min]，总住院时间[（10．4±5．2） d比（14．8±6．0） d]、术后输液天数[（4．5±2．8） d比（8．9±4．6） d]及术后住院时间[（5．1±3．2） d比（9．9±4．8） d]缩短，术后总并发症发生率（3．2％比16．2％）及总费用[（20334．1±8013．2）元比（23762．0±6776．4）元]降低（P＜0．05）。 T管引流常用于术前总胆红素水平高、存在阻塞性黄疸、胆道感染或胆总管扩张明显的患者。结论腹腔镜胆总管探查术安全、可行，腹腔镜下胆总管一期缝合更具微创优势。

Objective To assess the safety and efficacy of laparoscopic common bile duct （ CBD） exploration for choledocholithiasis associated with cholelithiasis .Methods A retrospective study was con-ducted on all patients who underwent laparoscopic CBD exploration at the Affiliated Shantou Hospital of Sun Yat-sen University from January 2012 to December 2015 .Their demographic , intraoperative , postoperative and follow-up data were analyzed .Results Of 376 patients who underwent laparoscopic CBD exploration , 339 patients had primary closure （ the primary closure group ） and 37 patients had T-tube drainage （ the T-tube drainage group）.The primary closure group was associated with a shorter operative time [（120.0 ±39. 1） min vs.（165.8 ±49.9） min], hospitalization stay [（10.4 ±5.2） d vs.（14.8 ±6.0） d], postopera-tive intravenous infusion time [（4.5 ±2.8） d vs.（89.±4 .6） d], postoperative hospitalization stay [（5. 1 ±3.2） d vs.（9.9 ±4.8） d], as well as a lower postoperative complication rate （3.2% vs.16.2%） and a lower total hospitalization expenses [（20 334.1 ±8 013.2） ￥ vs.（23 762.0 ±6 776.4） ￥] when compared with the T-tube drainage group （P〈0.05）.T-tube drainage was frequently used in patients with a high total bilirubin , severe obstructive jaundice , biliary tract infection , and an obviously dilated common bile duct.Conclus ions Laparoscopic CBD exploration was safe and feasible in treating choledocholithiasis associated with cholelithiasis .Laparoscopic CBD primary closure produced better results than T-tube drain-age.