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中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (06) : 344 -347. doi: 10.3877/cma.j.issn.2095-3232.2015.06.005

所属专题: 文献

临床研究

腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的临床应用
黄振添1,(), 谢昭雄1, 陈佳佳1, 陈美双1, 周铨1, 柯映平1   
  1. 1. 521000 广东省潮州市中心医院普通外科
  • 收稿日期:2015-09-22 出版日期:2015-12-10
  • 通信作者: 黄振添

Clinical application of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy

Zhentian Huang1,(), Zhaoxiong Xie1, Jiajia Chen1, Meishuang Chen1, Quan Zhou1, Yingping Ke1   

  1. 1. Department of General Surgery, Chaozhou Central Hospital, Chaozhou 521000, China
  • Received:2015-09-22 Published:2015-12-10
  • Corresponding author: Zhentian Huang
  • About author:
    Corresponding author: Huang Zhentian, Email:
引用本文:

黄振添, 谢昭雄, 陈佳佳, 陈美双, 周铨, 柯映平. 腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的临床应用[J]. 中华肝脏外科手术学电子杂志, 2015, 04(06): 344-347.

Zhentian Huang, Zhaoxiong Xie, Jiajia Chen, Meishuang Chen, Quan Zhou, Yingping Ke. Clinical application of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2015, 04(06): 344-347.

目的

探讨腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的安全性及疗效。

方法

回顾性研究2011年1月至2014年12月在潮州市中心医院接受诊治的178例胆总管结石患者临床资料。其中男83例,女95例;平均年龄(46±3)岁。所有患者均签署知情同意书,符合医学伦理学规定。所有患者均行腹腔镜联合胆道镜胆总管切开取石术,根据胆总管切口处理方式不同将患者分为一期缝合组和T管引流组,取石后一期缝合组采用胆总管一期缝合;T管引流组采用"T"管引流。观察两组患者手术时间、排气时间、住院时间、住院费用、术后并发症等指标。两组患者观察指标比较采用t检验或χ2检验。

结果

两组患者均手术顺利。一期缝合组患者的手术时间、排气时间、住院时间、住院费用分别为(119±18)min、(25±7)h、(6±1)d、(1.2±0.2)万元,与T管引流组的(136±20)min、(38±8)h、(10±1)d、(1.5±0.2)万元相比,差异有统计学意义(t=2.38,5.00,7.21,3.87;P<0.05)。一期缝合组患者术后并发症发生率为8%(3/37)明显低于T管引流组的12%(17/141) (χ2=3.28,P<0.05)。一期缝合组术后发生胆漏3例,切口感染1例;T管引流组胆漏1例,胆囊窝积液5例,切口感染11例,粘连性肠梗阻10例,所有患者均经对症处理后治愈。

结论

腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合术安全、有效,具有恢复快,费用低、并发症发生率低等优势。

Objective

To investigate the safety and curative effect of common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy.

Methods

Clinical data of 178 patients with choledocholithiasis diagnosed and treated in Chaozhou Central Hospital between January 2011 and December 2014 were retrospectively studied. Among the 178 patients, 83 were males and 95 were females with the average age of (46±3) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent laparoscopic and choledochoscopic choledocholithotomy and were divided into the primary closure group and the T-tube drainage group according to the different treatment for the incision of choledocholithotomy. The patients in the primary closure group underwent primary closure of common bile duct and the patients in the T-tube drainage group received T-tube drainage following choledocholithotomy. The operation duration, exhaust time, length of stay, hospitalization expenses and postoperative complication of two groups were observed. The observation indexes of two groups were compared using t test or Chi-square test.

Results

The patients in two groups completed choledocholithotomy successfully. The operation duration, exhaust time, length of stay, hospitalization expenses were respectively (119±18) min, (25±7) h, (6±1) d, (12 000±2 000) yuan in the primary closure group, and were respectively (136±20) min, (38±8) h, (10±1) d, (15 000±2 000) yuan in the T-tube drainage group. And significant difference was observed (t=2.38, 5.00, 7.21, 3.87; P<0.05). The incidence of postoprative complication in the primary closure group was 8%(3/37), which was significantly lower than 12%(17/141) in the T-tube drainage geoup (χ2=3.28, P<0.05). In the primary closure group, 3 patients developed bile leakage and 1 developed incision infection. In the T-tube drainage group, 1 patient developed bile leakage, 5 gallbladder fossa hydrops, 11 incision infection and 10 adhesive intestinal obstruction. All patients recovered after symptomatic treatments.

Conclusion

Common bile duct primary closure in laparoscopic and choledochoscopic choledocholithotomy is safe, effective and has the advantages of quick recovery, low costs and low complication incidence.

表1 两组胆总管结石患者围手术期资料比较
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