经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后 一期缝合中的应用价值
| 作者: |
1陈章彬,
1陈见中,
1滕毅山
1 昆明医科大学第二附属医院 肝胆胰外科三病区，云南 昆明 650101 |
| 通讯: |
滕毅山
Email: 13577193929@163.com |
| DOI: | 10.3978/.2018.01.004 |
摘要
目的：探讨经皮经肝穿刺胆道引流术（PTCD）在腹腔镜下胆道探查术后一期缝合中的应用价值。
方法：回顾性分析2015年6月—2017年6月昆明医科大学第二附属医院肝胆胰外科三病区收治的65例胆囊结石伴胆总管结石行腹腔镜下胆道探查术并一期缝合患者的临床资料。其中33例术前行PTCD治疗，术后保留PTCD管引流（PTCD组），32例未行PTCD治疗（非PTCD组）。比较两组患者的相关临床指标。
结果：65例患者手术均成功，无中转开腹。与非PTCD组比较，PTCD组手平均术时间（119.5 min vs. 136.6 min）、术中出血量（44.70 mL vs. 62.81 mL）、术后排气时间（9.52 h vs. 11.13 h）、住院时间（11.85 d vs. 13.53 d）、住院费用（1.28万元vs. 1.44万元）均明显减少（均P<0.05），两组术后直接胆红素术水平均较术前下降，但两组间手术前后直接胆红素术水平差异均无统计学意义（均P>0.05），PTCD组与非PTCD组术后并发症发生率无统计学差异（3.0% vs. 15.6%，P=0.087）。
结论：胆囊结石伴胆总管结石患者行胆道探查术后一期缝合时，术前经超声检查胆总管直径≥1.0 cm，即使没有严重肝功能损伤，亦可置入PTCD，有利于肝功能恢复、降低平均住院时间及费用。
关键词：
胆囊结石病；胆总管结石病；腹腔镜；引流术
方法：回顾性分析2015年6月—2017年6月昆明医科大学第二附属医院肝胆胰外科三病区收治的65例胆囊结石伴胆总管结石行腹腔镜下胆道探查术并一期缝合患者的临床资料。其中33例术前行PTCD治疗，术后保留PTCD管引流（PTCD组），32例未行PTCD治疗（非PTCD组）。比较两组患者的相关临床指标。
结果：65例患者手术均成功，无中转开腹。与非PTCD组比较，PTCD组手平均术时间（119.5 min vs. 136.6 min）、术中出血量（44.70 mL vs. 62.81 mL）、术后排气时间（9.52 h vs. 11.13 h）、住院时间（11.85 d vs. 13.53 d）、住院费用（1.28万元vs. 1.44万元）均明显减少（均P<0.05），两组术后直接胆红素术水平均较术前下降，但两组间手术前后直接胆红素术水平差异均无统计学意义（均P>0.05），PTCD组与非PTCD组术后并发症发生率无统计学差异（3.0% vs. 15.6%，P=0.087）。
结论：胆囊结石伴胆总管结石患者行胆道探查术后一期缝合时，术前经超声检查胆总管直径≥1.0 cm，即使没有严重肝功能损伤，亦可置入PTCD，有利于肝功能恢复、降低平均住院时间及费用。
Application value of percutaneous transhepatic cholangial drainage in laparoscopic common bile duct exploration with primary closure
CorrespondingAuthor:TENG Yishan Email: 13577193929@163.com
Abstract
Objective: To evaluate the application value of percutaneous transhepatic cholangial drainage (PTCD) in laparoscopic common bile duct exploration (LCBDE) with primary closure.
Methods: The clinical data of 65 patients with gallbladder stones and concomitant bile duct stones undergoing LCBDE and primary closure in the Third Division of Hepatopancreatobiliary Surgery of the Second Affiliated Hospital, Kunming Medical University from June 2015 to June 2016 were retrospectively analyzed. Of the patients, 33 cases received preoperative PTCD treatment and retention of the PTCD tube for postoperative drainage (PTCD group), and 32 cases did not receive PTCD treatment (non-PTCD group). The main clinical variables between the two groups of patients were compared.
Results: Operation was successfully performed in all the 65 patients, without any open conversion. In PTCD group compared with non-PTCD group, the average operative time (119.5 min vs. 136.6 min), intraoperative blood loss (44.70 mL vs. 62.81 mL), time to first gas passage (9.52 h vs. 11.13 h), length of postoperative hospital stay (11.85 d vs. 13.53 d), and hospitalization cost (12 800 yuan vs. 14 400 yuan) were all significantly reduced (all P<0.05). The direct bilirubin levels in both group were decreased compared with their preoperative values, but the pre- and postoperative direct bilirubin levels showed no significant difference between the two groups (both P>0.05). There was no significant difference in incidence of postoperative complications between PTCD group and no-PTCD group (3.0% vs. 15.6%, P=0.087).
Conclusion: In patients with gallbladder stones and concomitant bile duct stones undergoing LCBDE and primary closure, as long as the diameter of the bile duct is greater than 1.0 cm, even if there is no severe liver injury, PTCD placement is recommended, which may be helpful for liver function recovery, and reducing the length and cost of hospitalization.
Keywords：
Cholecystolithiasis; Choledocholithiasis; Laparoscopes; Drainage
Methods: The clinical data of 65 patients with gallbladder stones and concomitant bile duct stones undergoing LCBDE and primary closure in the Third Division of Hepatopancreatobiliary Surgery of the Second Affiliated Hospital, Kunming Medical University from June 2015 to June 2016 were retrospectively analyzed. Of the patients, 33 cases received preoperative PTCD treatment and retention of the PTCD tube for postoperative drainage (PTCD group), and 32 cases did not receive PTCD treatment (non-PTCD group). The main clinical variables between the two groups of patients were compared.
Results: Operation was successfully performed in all the 65 patients, without any open conversion. In PTCD group compared with non-PTCD group, the average operative time (119.5 min vs. 136.6 min), intraoperative blood loss (44.70 mL vs. 62.81 mL), time to first gas passage (9.52 h vs. 11.13 h), length of postoperative hospital stay (11.85 d vs. 13.53 d), and hospitalization cost (12 800 yuan vs. 14 400 yuan) were all significantly reduced (all P<0.05). The direct bilirubin levels in both group were decreased compared with their preoperative values, but the pre- and postoperative direct bilirubin levels showed no significant difference between the two groups (both P>0.05). There was no significant difference in incidence of postoperative complications between PTCD group and no-PTCD group (3.0% vs. 15.6%, P=0.087).
Conclusion: In patients with gallbladder stones and concomitant bile duct stones undergoing LCBDE and primary closure, as long as the diameter of the bile duct is greater than 1.0 cm, even if there is no severe liver injury, PTCD placement is recommended, which may be helpful for liver function recovery, and reducing the length and cost of hospitalization.