胆道注水试验在腹腔镜下胆总管探查术中的应用价值
| 作者: |
1陈金明,
1刘贺,
1张冉,
1刘中华,
1史赢,
1李强,
1孟凡宇,
1于艳龙
1 内蒙古医科大学赤峰临床医学院 肝胆外科，内蒙古 赤峰 024000 |
| 通讯: |
于艳龙
Email: yuyanlong1895@163.com |
| DOI: | 10.3978/.2018.08.011 |
摘要
目的：评估胆道注水试验在腹腔镜下胆总管探查术（LCBDE）中的应用价值。
方法：采用前瞻性队列研究方法，选择内蒙古医科大学赤峰临床医学院 2016 年 1 月—2017 年 10 月 95 例行 LCBDE 取石的患者并随机分为研究组（46 例）与对照组（49 例），术中研究组通过胆道镜下胆道注水试验观察 Oddi 括约肌（SO）功能状态来决定行胆总管一期缝合或 T 管引流，对照组则通过常规方法判断。比较两组相关临床指标。
结果：两组患者术前一般资料差异无统计学意义（均 P>0.05）；两组手术时间无统计学差异（P>0.05）；研究组胆总管一期缝合率明显高于对照组（26.1% vs. 10.2%，χ2=4.074，P=0.044）。两组均无死亡等严重并发症总并发症发生、总并发症与各并发症发生率均无统计学意义（均 P>0.05）。两组患者住院费用、住院时间、腹腔引流时间均无统计学差异（均 P>0.05）。两组术后半年内均无结石复发。
结论：胆道注水试验能够安全有效评价 SO 功能，降低 T 管留置率，从而避免盲目留置 T 管给患者带来的不适和痛苦及 T 管相关并发症，符合目前加速康复外科理念。
关键词：
胆总管结石病；腹腔镜检查；奥狄括约肌
方法：采用前瞻性队列研究方法，选择内蒙古医科大学赤峰临床医学院 2016 年 1 月—2017 年 10 月 95 例行 LCBDE 取石的患者并随机分为研究组（46 例）与对照组（49 例），术中研究组通过胆道镜下胆道注水试验观察 Oddi 括约肌（SO）功能状态来决定行胆总管一期缝合或 T 管引流，对照组则通过常规方法判断。比较两组相关临床指标。
结果：两组患者术前一般资料差异无统计学意义（均 P>0.05）；两组手术时间无统计学差异（P>0.05）；研究组胆总管一期缝合率明显高于对照组（26.1% vs. 10.2%，χ2=4.074，P=0.044）。两组均无死亡等严重并发症总并发症发生、总并发症与各并发症发生率均无统计学意义（均 P>0.05）。两组患者住院费用、住院时间、腹腔引流时间均无统计学差异（均 P>0.05）。两组术后半年内均无结石复发。
结论：胆道注水试验能够安全有效评价 SO 功能，降低 T 管留置率，从而避免盲目留置 T 管给患者带来的不适和痛苦及 T 管相关并发症，符合目前加速康复外科理念。
Application value of biliary water injection test in laparoscopic common bile duct exploration
CorrespondingAuthor:YU Yanlong Email: yuyanlong1895@163.com
Abstract
Objective: To evaluate the application value of biliary water injection test in laparoscopic common bile duct exploration (LCBDE).
Methods: Using a prospective cohort design, 95 patients undergoing LCBDE and stone extraction from January 2016 to October 2017 in Chifeng Clinical Medical School of Inner Mongolia Medical University were enrolled and randomly designated to study group (46 cases) and control group (49 cases). Performance of primary closure of the common bile duct or T-tube drainage was decided by observation of the status of the sphincter of Oddi (SO) through choledochoscopic biliary water injection test in study group, while that was judged by conventional methods in control group. Th e relevant clinical variables were compared between the two groups of patients.
Results: Th ere were no signifi cant diff erences in preoperative general data between the two groups (all P>0.05). The operative time showed no significant difference between the two groups (P>0.05), but the primary choledochal closure rate in study group was significantly higher than that in control group (26.1% vs. 10.2%, χ2=4.074, P=0.044). No death or severe complications occurred in the two groups, and both the overall incidence of complications and incidence of each complication also showed no significant differences between the two groups (all P>0.05). No significant differences were noted in hospitalization costs, length of postoperative hospital stay and abdominal drainage time between the two groups (all P>0.05). No stone recurrence occurred within half a year in both groups.
Conclusion: The biliary water injection test can safely and effectively evaluate the SO function and reduce the T-tube placement, and thereby avoid the discomfort and pain caused by unnecessary T-tube indwelling and the associated complications, which is in accordance with the current concept of enhanced recovery after surgery.
Keywords：
Choledocholithiasis; Laparoscopy; Sphincter of Oddi
Methods: Using a prospective cohort design, 95 patients undergoing LCBDE and stone extraction from January 2016 to October 2017 in Chifeng Clinical Medical School of Inner Mongolia Medical University were enrolled and randomly designated to study group (46 cases) and control group (49 cases). Performance of primary closure of the common bile duct or T-tube drainage was decided by observation of the status of the sphincter of Oddi (SO) through choledochoscopic biliary water injection test in study group, while that was judged by conventional methods in control group. Th e relevant clinical variables were compared between the two groups of patients.
Results: Th ere were no signifi cant diff erences in preoperative general data between the two groups (all P>0.05). The operative time showed no significant difference between the two groups (P>0.05), but the primary choledochal closure rate in study group was significantly higher than that in control group (26.1% vs. 10.2%, χ2=4.074, P=0.044). No death or severe complications occurred in the two groups, and both the overall incidence of complications and incidence of each complication also showed no significant differences between the two groups (all P>0.05). No significant differences were noted in hospitalization costs, length of postoperative hospital stay and abdominal drainage time between the two groups (all P>0.05). No stone recurrence occurred within half a year in both groups.
Conclusion: The biliary water injection test can safely and effectively evaluate the SO function and reduce the T-tube placement, and thereby avoid the discomfort and pain caused by unnecessary T-tube indwelling and the associated complications, which is in accordance with the current concept of enhanced recovery after surgery.