腹腔镜技术在胆道外科的应用:单中心23年回顾性分析

Development of laparoscopic technology in biliary surgery in the past 23 years: a single-center experience

目的分析解放军总医院23年间收治胆道外科患者的腹腔镜手术情况,探讨腹腔镜技术在胆道外科的发展现状。方法根据相关纳入标准回顾性分析解放军总医院胆道外科1992年4月~2014年12月期间收治的连续11419例行腹腔镜手术患者的临床资料,描述腹腔镜技术应用于胆道外科23年间的病种分布情况。进而以2003年12月31日为界限,将患者分为早期腹腔镜手术组和近期腹腔镜手术组,对2组患者的疾病种类等资料进行分析比较。结果(1)解放军总医院胆道外科1992年4月~2014年12月这23年间收治的行腹腔镜手术患者共11419例,占同期胆道外科手术患者的56.3%。其中男性4701例,女性6718例,女∶男=1.43∶1;年龄6~93岁,平均年龄50.9岁;(2)在所有患者中,胆囊结石和胆囊息肉患者所占比例最高,分别为80.83%和12.53%。胆囊结石患者的腹腔镜手术率为84.81%,肝外胆管结石患者的腹腔镜手术率为34.91%,而胆道恶性肿瘤患者的腹腔镜手术率较低;(3)在所行腹腔镜术式中,LC手术占据绝大部分,约96.18%;其次为肝外胆管结石的腹腔镜术式,一期缝合术占1.38%,传统的T管引流术占0.90%,而经胆囊管取石占0.72%。对于恶性肿瘤而言,腹腔镜技术还主要用于术中探查,占0.34%;(4)通过早期和近期两组腹腔镜手术患者的对比分析,腹腔镜技术在胆道外科,尤其是胆囊良性疾病和肝外胆管结石中的使用率呈明显上升趋势(P<0.05)。结论随着腹腔镜技术在胆道外科中的推广应用和发展,其逐渐取代传统开腹手术,成为治疗胆道外科常见良性疾病的金标准。

Objective To summarize the 23- year experience of laparoscopic biliary surgery in General Hospital of PLA and evaluate the application of laparoscopic surgery in the treatment of biliary diseases. Methods We retrospectively analyzed the clinical data of 11 419 consecutive patients with biliary diseases undergoing laparoscopic surgery from April, 1992 and December, 2014. The disease spectrum was compared between patients treated before December 31, 2003 and those treated after the time point. Results The 11419 patients receiving laparoscopic surgery accounted for 56.3% of the total patients undergoing biliary surgeries during the 23 years, including 4701 male and 6718 female patients with a mean age of 50.9±13.2years(6-93 years). Most(80.83%) of the patients received laparoscopic surgery for gallbladder stones, and 12.53% patients had the operation for gallbladder polyps. The laparoscopic operation rate was 84.81% in patients with gallbladder stones and34.91% in patients with extrahepatic bile duct stones, but remained low in patients with biliary carcinoma. In laparoscopic operations, laparoscopic cholecystectomy was the most frequent(96.18%) followed by operations for extrahepatic bile duct stones, in which primary suture accounted for 1.38%, traditional T tube drainage for 0.90% and laparoscopic transcystic duct exploration for 0.72%. For malignant tumors, laparoscopic technique was used mainly for the purpose of exploration(0.34%).The application of laparoscopic technique in biliary surgery tended to increase after the year 2004, especially for benign gallbladder diseases and extrahepatic bile duct stones(P<0.05). Conclusion Laparoscopic technique in biliary surgery is gradually replacing the traditional open operation and becomes the gold standard for the treatment of benign biliary diseases.