腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析

杨彦; 林师佈; 韩霖; 黄小龙; 涂伟

doi:10.3969/j.issn.1001-5256.2018.03.015

腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析

DOI: 10.3969/j.issn.1001-5256.2018.03.015

海南医学院第一附属医院肝胆胰外科

基金项目:

海南省自然科学基金面上项目(20168299)；

详细信息

中图分类号: R657.42
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出版历程
- 出版日期: 2018-03-20

Clinical effect of primary duct closure in laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration among patients with gallstones complicated by common bile duct stones

Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University

Research funding:

摘要

摘要:
目的探讨腹腔镜联合胆道镜胆总管探查一期缝合术的安全性和有效性。方法回顾性分析2015年7月-2017年7月海南医学院第一附属医院肝胆胰外科收治的76例胆囊结石合并胆总管结石患者,分别行腹腔镜胆囊切除+胆道镜胆总管探查术+一期缝合（PDC组）（n=20）和腹腔镜胆囊切除+胆道镜胆总管探查术+T管引流（TTD组）（n=56）,观察2组患者的手术时间、术中出血量、术后胃肠道功能恢复时间、腹腔引流管拔除时间、术后住院天数以及并发症（胆总管残余结石、胆瘘和胆道感染）发生率。术后随访212个月。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验。结果所有患者均成功实施腹腔镜手术,无1例中转开腹。PDC组和TTD组患者在手术时间[（106.2±15.8）min vs（147.5±23.2）min]、术后胃肠道功能恢复时间[（32.9±8.1）h vs（49.4±6.5）h]、腹腔引流管拔管时间[（3.5±1.3）d vs（5.7±2.6）d]、术后住院时间[（6.3±1.5）d vs（11.4±2.0）d]进行比较,差异均有统计学意义（t值分别为...
- 胆结石 /
- 腹腔镜检查 /
- 引流术
Abstract:
Objective To investigate the clinical effect and safety of primary duct closure ( PDC) in laparoscopic cholecystectomy ( LC) combined with laparoscopic common bile duct exploration ( LCBDE) . Methods A retrospective analysis was performed for 76 patients with gallstones complicated by common bile duct stones who were admitted to Department of Hepatobiliary and Pancreatic Surgery in The First Affiliated Hospital of Hainan Medical University from July 2015 to July 2017, and among these patients, 20 underwent LC + LCBDE + PDC ( PDC group) and 56 underwent LC + LCBDE + T-tube drainage ( TTD) ( TTD group) . The two groups were observed and compared in terms of time of operation, intraoperative blood loss, time to gastrointestinal functional recovery after surgery, time to extraction of abdominal drainage tube, length of postoperative hospital stay, and incidence rates of related complications ( residual common bile duct stones, biliary fistula, and biliary tract infection) . The patients were followed up for 2-12 months after surgery. The t-test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups. Results All patients underwent a successful laparoscopic surgery, and no patient was converted to open surgery. There were significant differences between the PDC group and the TTD group in time of operation ( 106. 2 ± 15. 8 min vs 147. 5 ± 23. 2 min, t =-2. 87, P = 0. 036) , time to gastrointestinal functional recovery after surgery ( 32. 9 ± 8. 1 h vs 49. 4 ± 6. 5 h, t =-3. 61, P = 0. 021) , time to extraction of abdominal drainage tube ( 3. 5 ±1. 3 d vs 5. 7 ±2. 6 d, t =-2. 64, P =0. 034) , and length of postoperative hospital stay ( 6. 3 ±1. 5 d vs 11. 4 ±2. 0 d, t =-26. 34, P < 0. 001) . There were no significant differences between the two groups in intraoperative blood loss, postoperative biliary fistula, residual bile duct stones, and biliary tract infection ( all P > 0. 05) . Conclusion A preliminary study of limited cases in our hospital shows that if patients are suitable, PDC is safe and effective in LC and LCBDE.
- cholelithiasis /
- laparoscopy /
- drainage

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参考文献(23)

[1]PODDA M, POLIGNANO FM, LUHMANN A, et al.Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis[J].Surg Endosc, 2016, 30 (3) :845-861.

[2]AHMED I, PRADHAN C, BECKINGHAM IJ, et al.Is a T-tube necessary after common bile duct exploration?[J].World J Surg, 2008, 32 (7) :1485-1488.

[3]CAI J, GONG RH, SUN DQ, et al.Clinical analysis of primary closure stutre of common bile duct exploration combined with three kinds of endoscopies[J].Chin J Endosc, 2015, 21 (3) :308-310. (in Chinese) 蔡军, 龚仁华, 孙登群, 等.三镜联合胆总管探查一期缝合临床分析[J].中国内镜杂志, 2015, 21 (3) :308-310.

[4]MEI Y, PENG CJ, ZHU HJ, et al.Technical difficulties of laparoscopic common bile duct exploration and their countermeasures for patients with history of upper abdominal surgery[J].J Clin Hepatol, 2014, 30 (8) :768-771. (in Chinese) 梅永, 彭慈军, 朱洪江, 等.上腹部术后行腹腔镜胆总管探查术的难点与对策[J].临床肝胆病杂志, 2014, 30 (8) :768-771.

[5]HUANG ZT, XIE ZX, CHEN JJ, et al.Clinical application of common bile duct primary closure in laparoscopic and choledochoscopic[J/CD].Chin J Hepatic Surg:Electronic Edition, 2015, 4 (6) :344-347. (in Chinese) 黄振添, 谢昭雄, 陈佳佳, 等.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/CD].中华肝脏外科手术学电子杂志, 2015, 4 (6) :344-347.

[6]STOKER ME, LEVEILLEE RJ, Mc CANN JC Jr, et al.Laparoscopic common bile duct exploration[J].J Laparoendosc Surg, 1991, 1 (5) :287-293.

[7]PHILLIPS EH, CARROLL BJ, PEARLSTEIN AR, et al.Laparoscopic choledochoscopy and extraction of common bile duct stones[J].World J Surg, 1993, 17 (1) :22-28.

[8]WILLS VL, GIBSON K, KARIHALOOT C, et al.Complications of biliary T-tubes after choledochotomy[J].ANZ J Surg, 2002, 72 (3) :177-180.

[9]CHEN AP, LU ML, GAO K, et al.Primary closure of bile duct incision of laparoscopic bile duct exploration 427 patients[J].Chin J Hepatobiliary Surg, 2005, 11 (6) :375-377. (in Chinese) 陈安平, 鲁美丽, 高珂, 等.腹腔镜胆总管探查术中即时缝合胆总管切口427例体会[J].中华肝胆外科杂志, 2005, 11 (6) :375-377.

[10]LIAO NS, LIN F, XIN DY.Clinical application of endoscopic nasobiliary drainage in laparoscopic common bile duct exploration and primary suture[J].Chin J Endosc, 2016, 22 (1) :28-31. (in Chinese) 廖南生, 林峰, 辛栋轶.鼻胆管引流在腹腔镜胆总管切开一期缝合中的临床应用[J].中国内镜杂志, 2016, 22 (1) :28-31.

[11]MANGLA V, CHANDER J, VINDAL A, et al.A randomized trial comparing the use of endobiliary stent and T-tube for biliary decompression after laparoscopic common bile duct exploration[J].Surg Laparosc Endosc Percutan Tech, 2012, 22 (4) :345-348.

[12]WU X, YANG Y, DONG P, et al.Primary closure versus T-tube drainage in laparoscopic common bile duct exploration:a meta-analysis of randomized clinical trials[J].Langenbecks Arch Surg, 2012, 397 (6) :909-916.

[13]YIN Z, XU K, SUN J, et al.Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming?A systematic review and meta-analysis[J].Ann Surg, 2013, 257 (1) :54-66.

[14]KHALED YS, MALDE DJ, de SOUZA C, et al.Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis[J].Surg Endosc, 2013, 27 (11) :4164-4170.

[15]ZHAO LD, BIE P, WANG SG, et al.Arangdomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy[J].Sury Endosc, 2008, 22 (7) :1595-1600.

[16]CHEN AP, GAO Y, LI HL, et al.Transabdominal consequent guidance technology of duodenoscopic sphincteropapillotomy during the course of laparoscopy:report of 905 cases[J].Chin J Oper Proc Gen Surg, 2016, 10 (3) :241-244. (in Chinese) 陈安平, 高原, 李华林, 等.腹腔镜下经腹顺行引导法内镜乳头切开术905例[J].中华普外科手术学杂志, 2016, 10 (3) :241-244.

[17]ZHANG HW, ZHOU JP, WEI F, et al.Clinical effect of primary duct closure and T-tube drainage after laparoscopic common bile duct exploration:a comparative analysis[J].J Clin Hepatol, 2016, 32 (6) :1149-1151. (in Chinese) 张海文, 周建鹏, 魏锋, 等.腹腔镜胆总管探查术后Ⅰ期缝合和T管引流的疗效比较[J].临床肝胆病杂志, 2016, 32 (6) :1149-1151.

[18]WANG GY, LI KW, LI F, et al.Primary closure versus T-tube drainage after laparoscopic common bile duct exploration[J].Chin J Gen Surg, 2013, 22 (2) :140-144. (in Chinese) 王贵阳, 李可为, 李甫, 等.腹腔镜胆总管探查术后一期缝合与T管留置的疗效比较[J].中国普通外科杂志, 2013, 22 (2) :140-144.

[19]KUANG NL, XU JN, WU JH, et al.Application of continuous full-thickness suture with barbed thread for laparoscopic common bile duct primary closure[J/CD].Chin J Hepat Surg:Electronic Edition, 2017, 6 (2) :92-95. (in Chinese) 邝乃乐, 许洁娜, 伍隽华, 等.倒钩线连续全层缝合在腹腔镜下胆总管一期缝合中的应用[J/CD].中华肝脏外科手术学电子杂志, 2017, 6 (2) :92-95.

[20]ZHANG SL, CHEN AP, LI HL, et al.A comparative study using the transabdominal route versus the transoral route in establishing nasobiliary drainage in laparoscopic surgery[J].Chin J Hepatobiliary Surg, 2016, 22 (8) :534-536. (in Chinese) 张胜龙, 陈安平, 李华林, 等.经腹与经口鼻胆管引流在腹腔镜手术中的应用比较[J].中华肝胆外科杂志, 2016, 22 (8) :534-536.

[21]CHEN AP, GAO Y, LI HL, et al.Combination of laparoscope, choledochoscope, and balloon nasobiliary exploration in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of common bile duct (report of 43 cases) [J].Chin J Bases Clin General Surg, 2016, 23 (2) :214-217. (in Chinese) 陈安平, 高原, 李华林, 等.腹腔镜、胆管镜、气囊鼻胆管同期治疗胆囊结石合并细径胆总管结石43例[J].中国普外基础与临床杂志, 2016, 23 (2) :214-217.

[22]TIAN DG, HUANG J, ZHANG J, et al.Study on the combined application of laparoscopic cholcystectomy and endoscopic sphincterotomy in treatment of cholecystolithiasis and secondary choledocholithiasis[J].Chin J Gen Surg, 2006, 15 (8) :579-581. (in Chinese) 田大广, 黄洁, 张捷, 等.LC与EST联合应用治疗胆囊结石继发性胆总管结石[J].中国普通外科杂志, 2006, 15 (8) :579-581.

[23]LI HL, CHEN AP, HU T, et al.Comparison of efficacy of nasobiliary drainage and T tube drainage after laparoscopic common bile duct exploration[J].Chin J Endosc, 2016, 22 (5) :12-16. (in Chinese) 李华林, 陈安平, 胡铤, 等.腹腔镜胆总管探查鼻胆管引流与T管引流的疗效比较[J].中国内镜杂志, 2016, 22 (5) :12-16.

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