上腹部手术后行腹腔镜胆总管探查术治疗胆总管结石临床观察

Clinical observation of laparoscopic common bile duct exploration for common bile duct stones after upper abdominal operation

目的 探讨腹腔镜胆总管探查术(LCBDE)治疗既往有上腹部手术史的胆总管结石患者的有效性和安全性。方法 选取2019年1月—2022年3月于河北省人民医院肝胆外科行LCBDE的60例胆总管结石患者进行回顾性分析。根据既往有无上腹部手术史分为有上腹部手术史患者25例(A组)和无上腹部手术史患者35例(B组),比较2组相关临床指标。结果 A组患者年龄高于B组(t=3.820,P<0.001),术前合并胆囊结石比例低于B组(χ~2=35.109,P<0.001)。2组患者均无结石残余、术中邻近脏器损伤和住院死亡病例。A组手术时间、术中出血量方面均高于B组,差异有统计学意义(t/Z=3.026、2.537,P=0.004、0.011)。与术前比较,A组术后3 d总胆红素(TBil)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷酰转肽酶(GGT)差异无统计学意义(P>0.05);B组患者术后3 d TBil、DBil水平差异无统计学意义(P>0.05),但术后3 d ALT、AST、GGT水平均降低(Z/P=3.447/0.001、3.865/<0.001、3.248/0.001)。2组术后3 d TBil、DBil、ALT、AST、GGT水平比较差异无统计学意义(P>0.05)。2组术后3 d WBC、C反应蛋白(CRP)、降钙素原(PCT)水平较术前均升高,且A组高于B组(t/P=2.229/0.030、7.841/<0.001、2.765/0.010)。2组患者术后均无胰腺炎、腹腔感染等严重并发症发生,术后并发症总发生率比较差异无统计学意义(P>0.05)。随访期间,B组出现结石复发1例。结论 上腹部手术后行LCBDE治疗胆总管结石是安全有效的。

Objective To investigate the efficacy and safety of laparoscopic common bile duct exploration(LCBDE) in the treatment of choledocholithiasis in patients with previous upper abdominal surgery.Methods A retrospective analysis was performed on 60 patients with choledocholithiasis who underwent LCBDE in the Department of Hepatobiliary Surgery of Hebei Provincial People’s Hospital from January 2019 to March 2022. According to the previous history of upper abdominal surgery, 25 patients with upper abdominal surgery history(group A) and 35 patients without upper abdominal surgery history(group B) were divided into two groups. The related clinical indicators were compared. Results The age of patients in group A was higher than that in group B(t=3.820,P<0.001), and the proportion of patients with preoperative cholecystolithiasis was lower than that in group B(χ~2=35.109,P<0.001). There were no residual stones, intraoperative adjacent organ damage and hospital death in both groups. The operation time and intraoperative blood loss of group A were higher than those of group B, and the difference was statistically significant(t/Z=3.026, 2.537,P=0.004, 0.011). Compared with preoperative, the total bilirubin(TBil), direct bilirubin(DBil), alanine aminotransferase(ALT), aspartate aminotransferase(AST), glutamyl There was no significant difference in transpeptidase(GGT)(P>0.05), and there was no significant difference in the levels of TBil and DBil in group B at 3 days after operation(P>0.05), but the levels of ALT, AST and GGT at 3 days after operation were not statistically significant(P>0.05). Both decreased(Z/P=3.447/0.001, 3.865/<0.001, 3.248/0.001). There was no significant difference in the levels of TBil, DBil, ALT, AST and GGT between the two groups at 3 days after operation(P>0.05). The levels of WBC, C-reactive protein(CRP) and procalcitonin(PCT) in both groups were higher than those before operation at 3 days after operation, and group A was higher than group B(t/P=2.229/0.030, 7.841/<0.001), 2.765/0.010). There were no serious complications such as pancreatitis and abdominal infection in the two groups after operation, and there was no significant difference in the total incidence of postoperative complications(P>0.05). During the follow-up period, there was 1 case of stone recurrence in group B. Conclusion LCBDE is safe and effective in the treatment of common bile duct stones after upper abdominal surgery.