腹腔镜胆总管探查治疗胆总管结石158例临床分析

Laparoscopic Common Bile Duct Exploration for Treatment of Common Bile Duct Stones:Clinical Analysis of 158 Cases

目的评价腹腔镜胆总管探查治疗胆总管结石的安全性及有效性。方法回顾性分析2015年1月至2019年12月本院收治的胆囊结石合并胆总管结石患者158例,根据胆囊管及胆总管直径、腹腔感染及组织水肿严重程度、手术方式将患者分为3组,A组:腹腔镜胆囊切除,经胆囊管胆总管胆道镜探查取石(16例);B组:腹腔镜胆囊切除,胆总管切开探查胆道镜取石,T管引流术(94例);C组:腹腔镜胆囊切除,胆总管切开探查胆道镜取石,一期胆总管缝合(48例)。评价手术时间、结石残留率、并发症率(出血、胆漏、伤口感染)。结果A组患者手术时间为(95.1±14.7)min,B组为(102.2±18.1)min,C组为(110.1±16.4)min,3组比较差异均无统计学意义(F=0.020,P=0.887)。A组有1例术后出现结石残留,B、C组无结石残留,总体结石清除率为99.4%。总体并发症率为1.9%,无围手术期死亡。结论在适合的人群中开展腹腔镜胆囊切除、胆总管探查取石安全有效。

Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones.Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection)rate were compared between groups.Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4)minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4%and the overall complication rate was 1.9%.There was no perioperative death.Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.