"隔膜"切开技术在腹腔镜经胆囊管胆总管探查术中的应用分析

Application of septum incision technique in laparoscopic transcystic common bile duct exploration

目的探讨"隔膜"切开技术在腹腔镜经胆囊管胆总管探查术(LTCBDE)中的作用。方法回顾性分析2020年4月至2023年3月苏州大学附属苏州九院22例应用"隔膜"(胆囊管与肝总管并行的一段膜状管壁)切开技术行LTCBDE的胆总管结石患者资料,其中男性13例,女性9例,年龄(54.4±20.3)岁。分析患者的手术时间、术后住院时间、术后并发症(胆漏、腹腔出血、腹腔感染等)及随访情况等。结果22例胆总管结石患者在LTCBDE手术中(其中经残余胆囊管行胆总管探查2例)均成功施行"隔膜"切开,均成功探查肝总管以及左右肝管开口、二级胆管开口等肝内胆管,且证实肝总管及肝内胆管通畅、无结石残留。手术时间(79.6±23.2)min,术后住院时间(6.3±1.7)d,术后无胆漏、腹腔出血、腹腔感染等并发症发生。随访结束时所有患者未出现胆道狭窄、结石残留及复发。结论"隔膜"切开技术增强了LTCBDE中肝门部胆管可视化程度,安全有效,增加了LTCBDE的适用范围及成功率。

Objective To investigate the role of septum incision technique in laparoscopic transcystic common bile duct exploration(LTCBDE).Methods The data of 22 patients with choledocholithiasis undergoing LTCBDE by septum(a membrane-like wall of the cystic duct running parallel to the common hepatic duct)incision technique at the Suzhou Ninth Hospital Affiliated to Soochow University from April 2020 to March 2023 were retrospectively analyzed,including 13 males and 9 females,aged(54.4±20.3)years.The operative time,postoperative hospital stay,postoperative complications(bile leakage,abdominal hemorrhage,abdominal infection,etc.)and follow-up data were collected and analyzed.Results All 22 patients(including two patients undergoing common bile duct exploration through the residual cystic duct)underwent the exploration of common hepatic duct,left and right hepatic duct openings,and secondary branch openings successfully.It was confirmed using this procedure that there were no obstruction of the common hepatic duct and intrahepatic bile ducts,or residual stones.The operation time was(79.6±23.2)min and the postoperative hospital stay was(6.3±1.7)d.No complications such as biliary leakage,abdominal hemorrhage or infection occurred after surgery.No cases of biliary stricture or residual stones were observed during short-term postoperative follow-ups.Conclusion The septum incision technique improved the visualization of hilar bile duct in LTCBDE,which could be a safe and effective procedure to facilitate the LTCBDE and increase its success rate.