腹腔镜胆总管探查术在有胆道手术史的胆总管结石患者中的临床应用

Clinical application of laparoscopic common bile duct exploration in patients with previous biliary tract surgery

目的探讨腹腔镜胆总管探查术在有胆道手术史的胆总管结石患者中的临床应用价值。方法回顾性分析2017年1月至2019年6月德阳市人民医院行腹腔镜胆总管探查术治疗有胆道手术史的45例胆总管结石患者的临床资料(观察组),与同期无胆道手术史行腹腔镜胆总管探查术的186例患者的临床资料(对照组)进行比较。比较两组手术时间、术中出血、中转率、结石清除率、住院时间及术后并发症等的差异。结果观察组手术时间较对照组时间长[(150.21±33.11)min vs(118.31±31.47)min,t=2.323,P<0.05],但两组术中出血量[(40.21±13.13)mL vs(39.33±12.13)mL]、手术中转率(2.2%vs 1.1%)、结石清除率(88.9%vs 89.2%)、住院时间[(8.61±2.91)d vs(7.61±2.93)d]及术后总并发症发生率(11.1%vs 8.6%)无统计学差异(P>0.05)。结论腹腔镜胆总管探查术在有胆道手术史的胆总管结石患者中的应用安全、可行、有效,有推广价值。

Objective To investigate the clinical value of laparoscopic common bile duct exploration(LCBDE)in patients with previous biliary tract surgery.Methods Clinical data of 45 patients with previous biliary tract surgery(the observation group)who underwent LCBDE from Jan.2017 to Jun.2019 in Deyang People’s Hospital were retrospectively analyzed,and they were compared with the data of 186 patients without previous biliary tract surgery(the control group)who underwent LCBDE in the same period.The differences of operation time,intraoperative hemorrhage,conversion rate,stone clearance rate,hospitalization time and postoperative complications between the two groups were compared.Results The operation time of the observation group was longer than that of the control group[(150.21±33.11)min vs(118.31±31.47)min,t=2.323,P<0.05].There was no statistical difference in intraoperative blood loss[(40.21±13.13)mL vs(39.33±12.13)mL],conversion rate(2.2%vs 1.1%),stone clearance rate(88.9%vs 89.2%),hospitalization time[(8.61±2.91)d vs(7.61±2.93)d]or incidence of postoperative complications(11.1%vs 8.6%)between the two groups(all P>0.05).Conclusion LCBDE is safe,feasible and effective for patients with previous biliary tract surgery,which is worthy of clinical application.