探讨腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中应用的可行性。

回顾性分析2020年1月至2021年12月在安徽医科大学第一附属医院行腹腔镜胆总管探查一期缝合的66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31例，女35例；年龄13~81岁，中位年龄57岁。根据胆总管直径将患者分为正常组（27例）和扩张组（39例）。正常组胆总管平均直径为（7.4±0.5）mm，扩张组为（12.8±2.4）mm。术中均采用腹腔镜胆囊切除术+腹腔镜胆总管探查术+胆道镜取石+胆总管一期缝合。观察两组患者围手术期情况和并发症发生情况。两组手术时间等比较采用秩和检验,胆漏发生率比较采用Fisher确切概率法。

正常组手术时间、术后住院时间和住院费用中位数分别为115（45）min、4（2）d、2.1（0.6）万元，扩张组相应为120（62）min、4（3）d、2.0（0.8）万元，两组差异均无统计学意义（Z=-0.235，-0.375，0.633；P>0.05）。正常组围手术期发生胆漏2例，经通畅引流、营养支持等保守治疗治愈；扩张组未发生胆漏；两组术后胆漏发生率比较差异无统计学意义（P=0.164）。两组术后3个月彩超均未见结石残留。随访期间两组均未出现胆管炎、胆道狭窄和胆道结石复发。

腹腔镜胆总管探查一期缝合在正常直径胆总管结石患者中应用安全、有效，不会增加住院时间、住院费用和术后并发症。

To evaluate the feasibility of laparoscopic common bile duct exploration and primary closure in patients with normal-diameter common bile duct stones.

Clinical data of 66 patients with common bile duct stones who underwent laparoscopic exploration and primary closure in the First Hospital of Anhui Medical University from January 2020 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 31 patients were male and 35 female, aged from 13 to 81 years, with a median age of 57 years.All patients were divided into the normal (n=27) and dilation groups (n=39) according to the diameter of common bile duct. The average diameter of common bile duct was (7.4±0.5) mm in the normal group and (12.8±2.4) mm in the dilation group. Laparoscopic cholecystectomy + laparoscopic common bile duct exploration + choledochoscopic lithotomy + primary closure of common bile duct were employed in all cases. Perioperative conditions and postoperative complications were observed between two groups. The operation time between two groups was compared by rank-sum test. The incidence of bile leakage was compared by Fisher's exact test.

In the normal group, the median operation time, length of postoperative hospital stay and hospitalization expenses were 115(45) min, 4(2) d and 2.1(0.6)×10⁴ Yuan, and 120(62) min, 4(3) d and 2.0(0.8)×10⁴ Yuan in the dilation group, and no significant difference was observed between two groups (Z=-0.235, -0.375, 0.633; P>0.05). In the normal group, biliary leakage occurred in 2 cases during perioperative period, which was cured by conservative treatment, such as drainage and nutritional support, etc. No bile leakage occurred in the dilation group. No significant difference was noted in the incidence of bile leakage between two groups (P=0.164). No residual stone was founded in two groups by Color Doppler ultrasound at postoperative 3 months. During postoperative follow-up, no cholangitis, biliary stricture and recurrence of bile duct stones were reported in two groups.

Laparoscopic common bile duct exploration and primary closure is safe and effective treatment for patients with normal-diameter common bile duct stones, which does not prolong the length of hospital stay, increase hospitalization expenses or elevate the incidence of postoperative complications.