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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 170 -173. doi: 10.3877/cma.j.issn.2095-3232.2021.02.011

所属专题： 文献；

临床研究

腹腔镜下经胆囊管胆总管探查取石术一期缝合治疗胆总管结石的安全性与疗效
陈家阳1, 陈杰桓2, 林树文1, 叶伟杰1, 刘熙1, 胡昆鹏3,†()   
  1. 1. 523000　广东省东莞市滨海湾中心医院普通外科
    2. 523000　广东省东莞市滨海湾中心医院超声科
    3. 510530　广州，中山大学附属第三医院岭南医院普通外科
  • 收稿日期:2020-12-11 出版日期:2021-04-10
  • 通信作者: 胡昆鹏
  • 基金资助:
    国家自然科学基金青年科学基金(81702375); 广东省自然科学基金(2016A030313200); 医院管理科研基金重点项目(018GLZD04)

Safety and efficacy of laparoscopic transcystic common bile duct exploration combined with primary suture in treatment of choledocholithiasis

Jiayang Chen1, Jiehuan Chen2, Shuwen Lin1, Weijie Ye1, Xi Liu1, Kunpeng Hu3,†()   

  1. 1. Department of General Surgery, Binhaiwan Central Hospital of Dongguan, Dongguan 523000, China
    2. Department of Ultrasound, Binhaiwan Central Hospital of Dongguan, Dongguan 523000, China
    3. Department of General Surgery, Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
  • Received:2020-12-11 Published:2021-04-10
  • Corresponding author: Kunpeng Hu
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陈家阳, 陈杰桓, 林树文, 叶伟杰, 刘熙, 胡昆鹏. 腹腔镜下经胆囊管胆总管探查取石术一期缝合治疗胆总管结石的安全性与疗效[J]. 中华肝脏外科手术学电子杂志, 2021, 10(02): 170-173.

Jiayang Chen, Jiehuan Chen, Shuwen Lin, Weijie Ye, Xi Liu, Kunpeng Hu. Safety and efficacy of laparoscopic transcystic common bile duct exploration combined with primary suture in treatment of choledocholithiasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 170-173.

目的

探讨腹腔镜下经胆囊管胆总管探查取石术（LTCBDE）一期缝合治疗胆总管结石的安全性与疗效。

方法

回顾性分析2016年1月至2019年12月东莞市滨海湾中心医院诊治的70例胆总管结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男33例，女37例；年龄37～72岁，中位年龄53岁。根据术式将患者分为LTCBDE组（36例）和胆总管切开+T管引流组（T管组，34例）。其中LTCBDE组采用LTCBDE一期缝合治疗，T管组采用胆总管切开取石+T管引流治疗。两组患者手术时间、术后住院时间、视觉模拟评分法（VAS）评分、消化疾病生活质量指数（GIQLI）评分等围手术期情况比较采用t检验。

结果

所有患者均成功完成手术。LTCBDE组平均手术时间、术后住院时间分别为（100±11） min、（5.1±0.9） d，明显短于T管组的（121±13） min、（7.0±1.3）d（t=-6.96，-7.01；P<0.05）。LTCBDE组术后24 h的VAS评分为（2.6±1.5）分，明显低于T管组的（3.9±1.2）分（t=-3.97，P<0.05）；而术后1个月的GIQLI评分为（115±4）分，明显高于T管组的（101±7）分（t=10.52，P<0.05）。随访期间两组均发现结石复发2例，无反流性胆管炎、胆道狭窄、乳头狭窄及胆管恶变等并发症。两组均无围手术期死亡病例。

结论

LTCBDE一期缝合治疗胆总管结石安全、有效，与传统胆总管切开T管引流相比，具有手术时间短、恢复快等优势。

关键词: 胆总管结石, 腹腔镜, 一期缝合, 引流术
Objective

To evaluate the safety and efficacy of laparoscopic transcystic common bile duct exploration (LTCBDE) combined with primary suture in the treatment of choledocholithiasis.

Methods

Clinical data of 70 patients with choledocholithiasis admitted to Binhaiwan Central Hospital of Dongguan from January 2016 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 33 patients were male and 37 female, aged from 37 to 72 years, with a median age of 53 years. All patients were divided into LTCBDE group (n=36) and choledochotomy + T-tube drainage group (T-tube group, n=34). In LTCBDE group, LTCBDE combined with primary suture was performed. In T-tube group, choledochotomy combined with T-tube drainage was performed. Perioperative conditions such as operation time, length of postoperative hospital stay, visual analogue scale (VAS) score and Gastrointestinal Quality of Life Index (GIQLI) score between two groups were statistically compared with t test.

Results

Operations in all patients were completed successfully. In LTCBDE group, the average operation time and length of postoperative hospital stay were (100±11) min and (5.1±0.9) d, significantly shorter than (121±13) min and (7.0±1.3) din T-tube group (t=-6.96, -7.01; P<0.05). In LTCBDE group, the VAS score at postoperative 24 h was 2.6±1.5, which was significantly lower than 3.9±1.2 in T-tube group (t=-3.97, P<0.05). The GIQLI score at postoperative 1 month in LTCBDE group was 115±4, significantly higher than 101±7 in T-tube group (t=10.52, P<0.05). During the postoperative follow-up, 2 cases in each group were found recurrence of calculus. No postoperative complications, such as reflux cholangitis, biliary stricture, nipple stricture and bile duct malignancy occurred. No perioperative death was reported in two groups.

Conclusions

LTCBDE combined with primary suture is a safe and efficacious method for the treatment of choledocholithiasis. Compared with traditional choledochotomy and T-tube drainage, it has multiple advantages such as shorter operation time and faster recovery, etc.

Key words: Choledocholithiasis, Laparoscopes, Primary suture, Drainage
表1 LTCBDE组与T管组胆总管结石患者一般资料比较
组别 例数 年龄（岁，±s） 性别（例，男/女） 胆总管直径（cm，±s） BMI（kg/m2，±s） ALT（U/L，±s）
LTCBDE组 36 53±5 17/18 1.5±0.2 30.1±2.0 89±12
T管组 34 51±4 16/19 1.6±0.3 29.3±3.0 94±9
检验值   t=1.84 χ2=0.06 t=-1.65 t=1.32 t=-1.96
P值   0.07 0.81 0.10 0.19 0.05
表2 LTCBDE组与T管组胆总管结石患者围手术期情况比较（±s）
组别 例数 手术时间（min） 术中出血量（ml） 术后住院时间（d） 引流管留置时间（d）
LTCBDE组 36 100±11 12±2 5.1±0.9 4.8±1.4
T管组 34 121±13 11±3 7.0±1.3 5.2±1.6
t值   -6.96 1.11 -7.01 -1.10
P值   <0.01 0.27 <0.01 0.28
表3 LTCBDE组与T管组胆总管结石患者围手术期VAS和GIQLI评分比较
组别 例数 VAS评分 GIQLI评分
术前 术后24 h 术前 术后1个月
LTCBDE组 36 5.9±1.3 2.6±1.5 94±4 115±4
T管组 34 5.5±1.8 3.9±1.2 95±5 101±7
t值   1.26 -3.97 -1.41 10.52
P值   0.21 <0.01 0.16 <0.01
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