探讨腹腔镜再次胆总管探查并一期缝合治疗胆总管结石的临床应用价值。

回顾性分析2011年1月至2015年1月在江苏大学附属宜兴医院行腹腔镜再次胆总管探查的58例胆总管结石患者临床资料。根据腹腔镜再次胆总管探查术后处理方式的不同，分为一期缝合组（缝合组）和T管引流组（引流组）。其中缝合组28例，男12例，女16例；平均年龄（49±11）岁；引流组30例，男17例，女13例；年龄（52±11）岁。所有患者均签署知情同意书，符合医学伦理学规定。采用超声刀、电凝钩锐性结合钝性分离腹腔粘连，暴露肝下间隙，切开胆总管前壁0.5 cm，置入胆道镜探查取石，确认肝内外胆管无结石残留后行一期缝合或T管引流。两组住院费用、术后住院时间比较采用t检验，率的比较采用χ²检验。

缝合组的住院费用、术后住院时间分别为（1.19±0.06）万元、（8.6±1.7）d，明显少于引流组的（1.35±0.04）万元、（13.5±2.3）d（t=-12.1，-9.17；P<0.05）。缝合组术后镇痛治疗率为36%（10/28），明显低于引流组的60%（18/30） （χ²=5.78，P<0.05）。所有患者随访6～24个月，均无发生胆管狭窄。

与T管引流相比，腹腔镜再次胆总管探查后一期缝合具有住院时间短、治疗费用低、术后疼痛轻等优势，是一种安全、可行的手术方式。

To investigate the clinical application value of laparoscopic common bile duct re-exploration with primary closure for common bile duct stones.

Clinical data of 58 patients with common bile duct stones who underwent laparoscopic common bile duct re-exploration in the Affiliated Yixing Hospital of Jiangsu University between January 2011 and January 2015 were retrospectively analyzed. According to the different treatments after laparoscopic common bile duct re-exploration, the patients were divided into the primary closure group (closure group, n=28) and T tube drainage group (drainage group, n=30). In the closure group, there were 12 males and 16 females with a mean age of (49±11) years old. In the drainage group, there were 17 males and 13 females with a mean age of (52±11) years old. The informed consents of all patients were obtained and the local ethical committee approval was received. Peritoneal adhesion was separated sharply and bluntly by ultrasound scalpel and coagulation hook. The sub-hepatic space was exposed, a 0.5-cm incision in the anterior wall of common bile duct was made, and choledochoscope was put inside for exploration and lithotomy. After all common bile duct stones were removed, primary common bile duct closure or T tube drainage was performed. Hospitalization expense and postoperative length of hospital stay in two groups were compared using t test. And the rate was compared using Chi-square test.

The hospitalization cost and postoperative length of hospital stay in the closure group was respectively (1.19±0.06)×10⁴ yuan and (8.6±1.7) d, significantly less than (1.35±0.04)×10⁴ yuan and (13.5±2.3) d in the drainage group (t=-12.1, -9.17; P<0.05). The rate of postoperative analgesia in the closure group was 36% (10/28), significantly lower than 60% (18/30) in the drainage group (χ²=5.78, P<0.05). All patients were followed up for 6-24 months, and no biliary stricture was observed.

Compared with T tube drainage, laparoscopic common bile duct re-exploration with primary closure is a safe and feasible surgical approach with the advantages of shorter length of hospital stay, less hospitalization expense and less postoperative pain.