腹腔镜胆管一期缝合在胆总管直径正常的老年胆总管结石患者中的应用

Application of laparoscopic primary suture of bile duct in elderly patients with normal diameter common bile duct

目的:探讨腹腔镜胆总管切开取石术后一期缝合治疗胆总管直径正常的老年胆总管结石患者的可行性与安全性。方法:回顾分析2018年8月至2021年5月收治的120例胆囊结石合并胆总管结石老年患者的临床资料。依据手术方式分为腹腔镜胆囊切除+胆总管切开取石+一期缝合术组(缝合组,n=64)与腹腔镜胆囊切除+胆总管切开取石+T管引流术组(T管组,n=56),对比两组患者术前临床资料及术中、术后相关指标。结果:两组患者术前临床资料、手术成功率、手术时间、术中出血量、术后胆漏、胆道狭窄、腹腔感染、残余结石情况差异无统计学意义(P>0.05)。与T管组相比,缝合组胃肠功能恢复更快[(31.0±2.1)h vs.(43.8±3.1)h]、术后住院时间更短[(8.3±0.9)d vs.(12.0±1.2)d]、住院费用更低[(20232.3±850.9)元vs.(23688.6±1306.3)元]、电解质紊乱发生率更低(1 vs.7),差异均有统计学意义(P<0.05)。结论:在严格把握手术指征及规范腔镜操作技术的前提下,腹腔镜胆总管切开取石术后一期缝合治疗胆总管直径正常的老年胆总管结石患者是安全、可行的,具有微创、康复快的优势。

Objective:To investigate the feasibility and safety of primary suture after laparoscopic choledocholithotomy in the treatment of elderly choledocholithiasis patients with normal common bile duct diameter.Methods:The clinical data of 120 patients with cholecystolithiasis combined with common bile duct stones from Aug.2018 to May 2021 were retrospectively analyzed.According to d ifferent operation methods,patients were divided into laparoscopic cholecystectomy+choledocholithotomy+primary suture group(primary suture group,n=64)and laparoscopic cholecystectomy+choledocholithotomy+T-tube drainage group(T-tube drainage group,n=56).The preoperative baseline data,intraoperative and postoperative related indicators of the two groups were compared.Results:There was no significant difference in preoperative baseline data,operative success rate,operative time,intraoperative blood loss,postoperative bile leakage,biliary stricture,abdominal infection and residual stones between the two groups(P>0.05).Compared with the T-tube drainage group,the primary suture group had faster recovery of gastrointestinal function[(31.0±2.1)h vs.(43.8±3.1)h],shorter postoperative hospital stay[(8.3±0.9)d vs.(12.0±1.2)d],lower hospitalization expenses[(20232.3±850.9)yuan vs.(23688.6±1306.3)yuan],and lower incidence of electrolyte disturbance(1 vs.7),the differences were statistically significant(P<0.05).Conclusions:Under the strict control of surgical indications and standard endoscopic operation techniques,primary closure after laparoscopic common bile duct exploration is safe and feasible in elderly choledocholithiasis patients with normal common bile duct diameter.It has the advantages of minimally invasive surgery and enhanced recovery after surgery.