腹腔镜胆总管探查一期缝合的技术要点

Technical key points of primary suture in laparoscopic common bile duct exploration

目的探讨腹腔镜胆总管探查一期缝合术的安全性和有效性。方法回顾性分析2020年1月至2021年12月在南京医科大学附属逸夫医院普外科收治胆囊结石合并胆总管结石拟行腹腔镜胆总管探查(LCBDE)一期缝合术的36例患者的临床资料。结果30例患者顺利完成LCBDE一期缝合,1例患者术中行内镜逆行胰胆管造影,5例患者术中放置T管。完成LCBDE一期缝合患者的手术时间55~180(105.77±36.30)min,术后住院时间5~16(7.00±2.07)d。患者术后丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、总胆红素、直接胆红素均较术前显著下降,差异有统计学意义(P<0.01)。1例患者术后出现胆漏,保持腹腔引流通畅,术后11 d治愈。结论LCBDE一期缝合术在临床上治疗胆囊结石合并胆总管结石是切实可行的,安全有效的,其技术要点在于确保胆管内无结石残留。

Objective To investigate the clinical effect and safety of laparoscopic common bile duct exploration(LCBDE)and primary suture of common bile duct.Methods A retrospective analysis was performed on the clinical data of 36 patients undergoing LCBDE and primary duct suture in treating cholecystolithiasis complicated with choledocholithiasis in the Sir Run Run Hospital of Nanjing Medical University from January 2020 to December 2021.Results LCBDE with primary suture was successfully performed in 30 patients,ERCP was conducted in one patient during operation,and T tube was placed in 5 patients.In the patients with LCBDE and primary suture,the operation time was 55-180(105.77±36.30)min,the postoperative hospital stay was 5-16(7.00±2.07)days,and the levels of alanine aminotransferase,aspartate transaminase,gamma-glutamyltransferase,total bilirubin and direct bilirubin decreased significantly compared with those before operation(P<0.01).One patient had bile leakage after operation and was cured 11 days after abdominal cavity unobstructed drainage.Conclusion In the treatment of cholecystolithiasis complicated with choledocholithiasis,LCBDE and primary suture is safe and effective,and its technical key point is to ensure that there is no residual stone in the bile duct.