3D腹腔镜在肝外胆管结石手术中的应用

Clinical application of three-dimensional laparoscopy in the treatment of extrahepatic bile duct stone

目的探讨3D腹腔镜在肝外胆管结石手术治疗中的临床应用。方法回顾性分析南方医科大学珠江医院2013年2月至2017年6月行腹腔镜微创治疗的80例肝外胆管结石患者临床资料,其中行3D腹腔镜手术42例(3D组),行2D腹腔镜手术38例(2D组)。观察分析两组患者的手术时间、术中出血量、术后腹腔引流量、术后住院时间、并发症、结石和胆管炎复发等指标。结果 3D组和2D组在肝外胆管结石数、胆总管直径、胆总管一期缝合率、T管引流率、胆管空肠吻合率方面的比较,无统计学差异(P>0.05)。3D组的手术时间[(81.4±11.6)min vs(91.3±15.9)min]、术中出血量[(22.1±6.1)m L vs(27.2±9.1)]m L、术后腹腔引流量[(34.5±15.7)m L vs(46.6±21.6)m L]均低于2D组(P<0.05);在术后住院时间[(4.6±1.6)d vs(5.1±1.5)d]、并发症发生率(4.8%vs 13.2%)方面,3D组也低于2D组,但比较无统计学差异(P>0.05);两组术后结石、胆管炎复发率无统计学差异(P>0.05)。结论 3D腹腔镜在肝外胆管结石手术中安全、微创、可靠。

Objective To evaluate the clinical application value of three-dimensional laparoscopy in the treatment of extrahepatic bile duct stone. Methods A total of 80 patients with extrahepatic bile duct stone from Feb. 2013 to Jun. 2017 who underwent the minimally invasive surgery in Zhujiang Hospital of Southern Medical University were retrospectively analyzed. Three-dimensional laparoscopy applied in 42 patients（3 D group）, and two-dimensional laparoscopy in 38 patients（2 D group）. The clinical therapeutic results including operation time, intraoperative blood loss, postoperative drainage, postoperative hospitalization duration, complication incidence, recurrence of stone and cholangitis were observed and analyzed. Results For the number of stones, the diameter of the common bile duct, the incidence of common bile duct primary suture, T-tube drainage and cholangioenterostomy, there were no significant differences between two groups（P〉0.05）. The operation time [（81.4±11.6） min vs（91.3±15.9） min], intraoperative blood loss volume [（22.1±6.1） mL vs（27.2±9.1） mL], postoperative drainage volume [（34.5±15.7） mL vs（46.6±21.6） mL] in 3 D group were less than those in 2 D group, the difference were significant（P〈0.05）. The postoperative hospitalization duration and complication incidence in two groups had no significant difference（P〉0.05）. The incidence of stone recurrence and cholangitis in two groups also had no significant difference（P〉0.05）. Conclusion The clinical application of three-dimensional laparoscopy in the treatment of extrahepatic bile duct stone is a safe, minimally invasive and effective therapic modality.