腹腔镜经胆囊管微切开一期缝合治疗胆囊管肝总管汇合部结石:附8例报告

Laparoscopic transcystic duct micro-incision and primary closure for stone at the junction of the cystic duct and common hepatic duct: a report of 8 cases

目的:探讨腹腔镜经胆囊管微切开一期缝合治疗胆囊管肝总管汇合部结石的有效性和安全性。方法:回顾性分析2015年12月—2017年12月内蒙古医科大学附属医院肝胆外科收治的8例胆囊管肝总管汇合部结石患者资料,所有患者均行腹腔镜胆囊切除+经胆囊管微切开一期缝合手术,部分患者加用胆道镜辅助操作。观察患者的手术时间、术中出血量、术后胃肠道功能恢复时间、腹腔引流管拔除时间、术后住院时间以及并发症发生率。术后随访3～24个月。结果:8例患者均成功实施腹腔镜操作,无中转开腹。手术时间(125.5±24.2)min、术后胃肠道功能恢复时间(28.9±8.2)h、腹腔引流管拔管时间(3.0±1.3)d、术后住院时间(5.3±1.5)d。患者术中无明显出血,术后胆汁漏1例、保守治愈。随访无结石残留及胆道狭窄。结论:腹腔镜经胆囊管微切开一期缝合治疗胆囊管肝总管汇合部结石是安全有效的,能够避免结石残留或者胆道探查T型管引流,但仍需进一步大样本的研究确证。

Objective: To investigate the efficacy and safety of laparoscopic transcystic duct micro-incision and primary closure for stone at the junction of the cystic duct and common hepatic duct. Methods: The clinical data of 8 patients with stone at the junction of the cystic duct and common hepatic duct treated in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Inner Mongolia Medical University from December 2015 to December 2017 were reviewed. All patients underwent laparoscopic cholecystectomy and micro-incision via cystic duct with primary closure, and some of them were assisted by choledochoscopic operation. The operative time, intraoperative blood loss, time to postoperative gastrointestinal functional recovery, time to drainage tube removal, length of postoperative hospital stay and incidence of complications were analyzed. The patients were followed up for 3 to 24 months after surgery.Results: Laparoscopic operations were successfully performed in all the 8 patients, without any open conversion. The operative time was(125.5±24.2) min, time to postoperative gastrointestinal functional recovery was(28.9±8.2) h, time to drainage tube removal was(3.0±1.3) d, and length of postoperative hospital stay was(5.3±1.5) d. No significant intraoperative bleeding was noted, and postoperative biliary fistula occurred in one case, which was cured by conservative treatment. No biliary stricture or residual stone was found during follow-up. Conclusion: Laparoscopic transcystic duct micro-incision and primary closure is safe and effective in treatment of stone at the junction of the cystic duct and common hepatic duct, which can also effectively avoid stone residual as well as bile duct exploration and T tube drainage. However, it still needs be verified by studies with large sample size.