腹腔镜胆总管探查一期缝合联合支架置入术治疗胆石病46例

Laparoscopic common bile duct exploration with one-stage suture combined with stent placement in 46 cases of cholelithiasis

目的探讨腹腔镜胆总管探查一期缝合联合胆管支架置入术治疗胆石症的疗效及安全性。方法回顾性分析2018年2月至2019年12月阜阳市第五人民医院行腹腔镜胆总管探查术的胆石症病人88例,其中观察组46例,采用腹腔镜胆总管探查一期缝合联合胆管支架置入术,对照组42例,仅采用腹腔镜胆总管探查一期缝合,比较两组手术情况(手术时间、术中出血量、腹腔引流时间、术后住院时间)及术后并发症情况(术后胆漏、胆管结石残余)。结果观察组腹腔引流时间[(5.08±0.53)d比(5.52±0.72)d]、术后住院时间[(6.37±0.64)d比(6.79±0.97)d]均优于对照组,差异有统计学意义(P<0.05);观察组手术时间[(124.37±6.57)min比(124.50±5.89)min]及术中出血量[(66.39±9.05)mL比(66.45±8.96)mL]与对照组比较,差异无统计学意义(P>0.05);术后并发症对照组并发胆漏、胆总管结石残留各2例,观察组出现胆总管结石残留1例,差异无统计学意义(P>0.05),所有病人经治疗后痊愈。结论腹腔镜胆总管探查一期缝合联合胆管支架置入术可减少胆石症病人术后住院时间、腹腔引流时间,是一种安全有效的方法,具有一定的优势,值得临床推广。

Objective To compare the efficacy and safety of Laparoscopic common bile duct exploration(LCBDE)with one-stage suture combined with stent placement in treating cholelithiasis.Methods The clinical data of 88 patients who underwent LCBDE in The Fifth People’s Hospital of Fuyang from February 2018 to December 2019 were retrospectively analyzed.Among them,46 cases in the observation group were treated LCBDE with one-stage suture combined with stent placement,while 42 cases in the control group were treated LCBDE.The operation conditions(operation time,intraoperative bleeding,abdominal drainage time,postoperative hotspot stay time)and postoperative complications(bile leakage and stone recurrence)of the two groups were analyzed and compared.Results The abdominal drainage time[(5.08±0.53)d vs.(5.52±0.72)d]and postoperative hospital stay[(6.37±0.64)d vs.(6.79±0.97]of the observation groupwere better than the control group,the difference was statistically significant(P<0.05);the operation time[(124.37±6.57)min vs.(124.50±5.89)min]and intraoperative bleeding[(66.39±9.05)mL vs.(66.45±8.96)mL]of the observation group were almost the same as the control group,the difference was not statistically significant(P>0.05);there were 2 cases of bile leakage and 2 cases of residual stone in the control group,there were 1 case of residual stone in the observation group,the difference of postoperative complications was not statistically significant(P>0.05),all the patients were cured after treatment.Conclusion LCBDE with one-stage suture combined with stent placement can reduce the hospitalization time and abdominal drainage time of patients with cholelithiasis.It is a safe and effective method,which has certain advantages and is worthy of clinical application.