探讨腹腔镜下C管胆道引流及胆总管一期缝合治疗肝外胆管结石的安全性及疗效。

回顾性研究2012年9月至2013年1月中山大学附属第三医院肝胆外科、中山大学附属第三医院岭南医院普外科、日本浅香山病院外科收治的41例肝外胆管结石患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。按手术方式将患者分为C管引流组19例和T管引流组22例。C管引流组男11例，女8例；年龄30~81岁，中位年龄51岁；行腹腔镜下胆囊切除、胆总管切开取石、C管引流术及胆总管一期缝合。T管引流组男10例，女12例；年龄25~76岁，中位年龄48岁；行腹腔镜下胆囊切除、胆总管切开取石及T管引流。两组患者的术中出血量、手术时间、术后住院时间和治疗周期比较采用t检验，两组术后胆漏的发生率比较采用Fisher确切概率法。

41例患者腹腔镜手术均获成功，无中转开腹病例。C管引流组和T管引流组患者的术中出血量分别为（47±30）、（55±30）ml，手术时间分别为（123±7）、（127±8）min，两组比较差异无统计学意义（t=0.86，1.75；P>0.05）。两组患者术后均未发现肝外胆管结石残余。两组患者术后拔管时各发生1例胆漏，行腹腔穿刺置管引流、保守治疗后痊愈，胆漏发生率比较差异无统计学意义（P>0.05）。C管引流组和T管引流组患者术后住院时间分别为（4.8±1.0）、（9.1±2.4）d,治疗周期分别为（4.8±1.0）、（15.6±2.5）d，C管引流组的术后住院时间和治疗周期较T管引流组明显缩短，差异有统计学意义（t=7.31，17.71；P<0.05）。

腹腔镜下C管胆道引流并胆总管一期缝合治疗肝外胆管结石是一种安全有效的手术方式，可明显缩短患者的术后住院时间和治疗周期。

To investigate the safty and effect of laparoscopic C tube drainage combining with primary common bile duct suture in the treatment of extrahepatic cholangiolithiasis.

Clinical data of 41 patients with extrahepatic cholangiolithiasis admitted in Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University, Department of General Surgery of Lingnan Hospital of the Third Affiliated Hospital of Sun Yat-sen University, and Department of Surgery, Asakayama Hospital of Japan from September 2012 to January 2013 were retrospectively studied. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were divided into two groups: the C tube drainage group (19 cases) and the T tube drainage group (22 cases). There were 11 males and 8 females in the C tube drainage group with age ranging from 30 to 81 years old and the median age of 51 years old, who received laparoscopic cholecystectomy, common bile duct exploration and C tube drainage. There were 10 males and 12 females with age ranging from 25 to 76 years old and the median age of 48 years old in the T tube drainage group, who received laparoscopic cholecystectomy, common bile duct exploration and T tube drainage. The intraoperative bleeding, surgical duration, postoperative length of hospital stay and curative period between two groups were compared by t test. The incidence of bile leakage were compared by Fisher definite probability test.

All the operations were successful without conversion to laparotomy. There were no significant differences in the intraoperative bleeding [(47±30)ml vs. (55±30)ml], the surgical duration [(123±7)min vs. (127±8)min] between two groups (t=0.86,1.75; P>0.05). No residual extrahepatic cholangiolithiasis was observed in two groups. Bile leakage was observed in one case respectively in each group and the patients were cured by percutaneous peritoneal drainage and conservative treatment. No significant difference was observed in the incidence of bile leakage between two groups(P>0.05). The postoperative length of hospital stay of C tube drainage group and T tube drainage group were (4.8±1.0)d, (9.1±2.4)d respectively, and the curative period were (4.8±1.0)d and (15.6±2.5)d respectively. The postoperative length of hospital stay and curative period in C tube drainage group were evidently shorter than those in T tube drainage group. There were significant differences between two groups (t=7.31,17.71; P<0.05).

Laparoscopic C tube drainage combining with primary suture of common bile duct is safe and effective in treating patients with extrahepatic cholangiolithiasis, and can evidently shorten the postoperative length of hospital stay and curative period of the patients.