探讨腹腔镜下经胆囊管汇入部微切开取石在细径胆总管结石合并胆囊结石患者中的应用价值。

回顾性分析2018年1月至2021年12月在南通大学附属江阴医院诊治的46例细径胆总管结石合并胆囊结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男28例，女18例；年龄21~74岁，中位年龄47岁。胆总管十二指肠上段内径0.6~0.8 cm。按手术方式不同分为微切开组（21例）和对照组（25例）。微切开组采用腹腔镜下经胆囊管汇入部微切开胆道取石，对照组采用腹腔镜下胆总管切开取石，观察患者围手术期情况。两组术后住院时间、引流管留置时间比较采用秩和检验，并发症发生率比较采用连续校正χ²检验。

微切开组术后住院时间、引流管留置时间中位数分别为6（5，7）、5（5，6）d，明显少于对照组的7（6，8）、6（6，7）d（Z=-3.055，-3.330；P<0.05）。微切开组胆漏发生率5%（1/21），对照组12%（3/25），差异无统计学意义（χ²=0.117，P>0.05）。两组术后胆漏均通过腹腔引流治愈。对照组1例术后7个月再发胆总管结石，再次手术发现胆囊管残留过长伴残余胆囊管结石，术后恢复良好。

对于细径胆总管结石合并胆囊结石患者，腹腔镜下经胆囊管汇入部微切开治疗疗效确切、恢复快，但术前应严格筛选合适患者，术后重点关注胆漏发生。

To evaluate the application value of laparoscopic micro-incision of cystic duct confluence in patients with small-diameter common bile duct stones complicated with cholecystolithiasis.

Clinical data of 46 patients with small-diameter common bile duct stones complicated with cholecystolithiasis admitted to Jiangyin People's Hospital Affiliated to Nantong University from January, 2018 to December, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 28 patients were male and 18 female, aged from 21 to 74 years, with a median age of 47 years. The inner diameter of the upper segment of duodenum of common bile duct was 0.6-0.8 cm. According to different surgical approaches, all patients were divided into the micro-incision group (n=21) and control group (n=25). In the micro-incision group, laparoscopic micro-incision of cystic duct confluence was performed, and laparoscopic common bile duct incision was carried out in the control group. Perioperative conditions of all patients were observed. The length of postoperative hospital stay and indwelling time of drainage tube were compared by rank-sum test. The incidence of postoperative complications was compared by Chi-square test with continuity correction.

In the micro-incision group, the median length of postoperative hospital stay and indwelling time of drainage tube were 6 (5, 7) d and 5 (5, 6) d, significantly shorter than 7(6, 8) d and 6(6, 7) d in the control group (Z=-3.055, -3.330; P<0.05). In the micro-incision group, the incidence of bile leakage was 5%(1/21) and 12%(3/25) in the control group, and the difference was not statistically significant (χ²=0.117, P>0.05). Postoperative bile leakage was treated by abdominal drainage in two groups. In the control group, 1 patient suffered from recurrent common bile duct stones at postoperative 7 months. Excessive cystic duct residual complicated with residual cystic duct stones was found in the re-operation, and the patient recovered well postoperatively.

For patients with small-diameter common bile duct stones complicated with cholecystolithiasis, laparoscopic mini-incision of the cystic duct confluence is an efficacious treatment, which can accelerate postoperative recovery. However, eligible patients should be strictly selected before surgery. Close attention should be paid in the incidence of postoperative bile leakage.