腹腔镜经胆囊管汇合部微切开胆总管探查术治疗胆总管结石的临床研究

The clinical study of laparoscopic transcystic approach with micro incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis

目的:探讨腹腔镜经胆囊管汇合部微切开胆总管探查术治疗胆总管结石的疗效及手术适应证。方法:回顾分析2018年1月至2022年9月收治的胆囊结石合并胆总管结石患者的临床资料,其中76例行腹腔镜经胆囊管汇合部微切开胆总管探查术(观察组),84例行腹腔镜胆总管探查、一期缝合术(对照组)。对比分析两组手术时间、出血量、带引流管时间、胃肠功能恢复时间、总住院时间、术后并发症等。结果:观察组与对照组手术时间[(103.49±21.70)min vs.(97.95±22.25)min]、术中出血量[(19.49±9.85)mL vs.(17.81±7.83)mL]差异无统计学意义(P>0.05);观察组术后带引流管时间[(2.89±1.04)d vs.(4.05±1.79)d]、胃肠功能恢复时间[(2.58±0.92)d vs.(3.17±1.04)d]、总住院时间[(8.87±1.30)d vs.(10.27±2.04)d]短于对照组(P<0.05)。两组均有胆漏(5.26%vs.13.10%)、结石残留(1.32%vs.3.57%)、胆道感染(2.63%vs.3.57%)发生,并发症发生率差异无统计学意义(P>0.05),均未发现胆管狭窄。结论:腹腔镜经胆囊管汇合部微切开胆总管探查术治疗胆总管结石安全、有效,利于术后早期恢复,但术前需充分评估手术适应证,选择合适的手术方式。

Objective:To investigate the efficacy and surgical indications of laparoscopic transcystic approach with micro incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis.Methods:The clinical data of the patients diagnosed with cholecystolithiasis and choledocholithiasis from Jan.2018 to Sep.2022 were retrospectively analyzed,including 76 patients who underwent laparoscopic transcystic approach with micro incision of the cystic duct confluence in common bile duct exploration(observation group)and 84 patients who underwent laparoscopic common bile duct exploration and primary suture(control group).The operative time,intraoperative bleeding volume,abdominal drainage time,gastrointestinal recovery time,total duration of hospitalization,and postoperative complication incidence of the two groups were compared and analyzed.Results:There was no significant difference in operation time[(103.49±21.70)min vs.(97.95±22.25)min]and intraoperative blood loss[(19.49±9.85)mL vs.(17.81±7.83)mL]between observation group and control group(P>0.05),but the abdominal drainage time[(2.89±1.04)d vs.(4.05±1.79)d],postoperative gastrointestinal recovery time[(2.58±0.92)d vs.(3.17±1.04)d],and total duration of hospitalization[(8.87±1.30)d vs.(10.27±2.04)d]in observation group were shorter than those in the control group(P<0.05).There was no statistical difference in the postoperative complications including bile leakage(5.26%vs.13.10%),residual calculi(1.32%vs.3.57%)and biliary tract infection(2.63%vs.3.57%)(P>0.05),and there was no cases of biliary stricture observed in the two groups.Conclusions:Laparoscopic transcystic approach with micro incision of the cystic duct confluence in common bile duct exploration for choledocholithiasis is a safe and effective method,which is conducive to early postoperative recovery.However,it is necessary to fully evaluate the surgical indications before operation and select appropriate surgical methods.