腹腔镜胆总管探查一期缝合胆道内支架管的应用经验

Clinical experience of using endobiliary stent for primary suture after laparoscopic common bile duct exploration

目的总结腹腔镜胆总管探查一期缝合胆道内支架管应用治疗胆总管结石的经验。方法回顾性分析我院自2016年1月至2018年1月期间96例胆总管结石病例,其中腹腔镜胆总管探查一期缝合组(一期组)47例,腹腔镜胆总管探查一期缝合胆道内支架置入组(支架组)49例,比较两种术式的手术相关情况(手术时间和术中出血量)、术后恢复情况(首次进食时间、腹腔引流时间及术后住院天数)、术后并发症(胆漏、腹腔出血、结石残留)。结果两组病例均治愈出院,无手术死亡,术后无结石残留。在首次进食时间、腹腔引流时间及术后住院天数,支架组优于一期组(P<0.05);在手术时间、术中出血量、术后并发症(出血、胆漏)发生率,两组病例之间的差异无统计学意义(P>0.05),4例胆漏病人(一期组3例,支架组1例)经短期引流后治愈,2例出血病人(一期组1例,支架组1例)经输血等保守治疗后治愈。支架组术后2～3周行胃镜检查拔除胆道内支架管,其中有部分病例胆道内支架管已自行排出。术后随访1～6月,无胆道结石复发、胆道狭窄。结论腹腔镜胆总管探查一期缝合胆道内支架管应用具有创伤少、恢复快、住院时间短、护理简单,不增加胆道并发症的发生率,是治疗胆总管结石的一种有效、可行方法。

Objective To investigate the feasibility of using endobiliary stent for primary suture after laparoscopic common bile duct exploration.Methods A total of 96 patients had laparoscopic common bile duct exploration between January 2016 and January 2018,47(49%),in whom underwent primary suture(primary suture group)and others(51%)received endobiliary stent implantation(endobiliary stent group).Operative parameters and outcomes in the two groups were compared.Results The patients of two groups were cured to discharge from hospital.No mortality nor stones residue were found in two groups.First feeding time,drainage tube removal time,and postoperative stay were all significantly shorter in the endobiliary stent group as compared to that in the primary suture group(P<0.05).Otherwise,surgical time,intraoperative blood loss,bile leakage,and postoperative bleeding between the two groups had no significant difference(P>0.05).Four patients suffered from bile leakage and recovered by short-period drainage,and two patients with postoperative bleeding were cured after blood transfusion.The stent was removed by gastroscopy 2-3 weeks postoperatively,while in some cases the stent was excreted spontaneously.The follow-up lasted for 1-6 months,and no stone recurrence or bile duct stenosis were found.Conclusion Using endobiliary stent for primary suture after laparoscopic common bile duct exploration is an effective and feasible method for common bile duct stone.It has better recovery and does not increase the incidence of biliary complications.