腹腔镜下胆总管探查取石术后胆总管一期缝合的疗效分析
| 作者: |
1温顺前,
1谢学弈,
1巫青,
1杨尚霖,
1陈俊鹏,
1廖冠群
1 南方医科大学附属佛山医院 肝胆外科，广东 佛山 528000 |
| 通讯: |
廖冠群
Email: drliaogq@qq.com |
| DOI: | 10.3978/.2018.02.005 |
摘要
目的：探讨腹腔镜下胆总管探查取石术后一期缝合的安全性及有效性。
方法：回顾性分析2013年6月—2016年9月南方医科大学附属佛山医院接受腹腔镜下胆总管探查取石患者临床资料，其中62例术中行一期缝合（研究组），38例行T管引流（对照组）。比较两组的相关临床指标。
结果：两组患者性别、BMI和胆总管直径无统计学差异（均P>0.05）；与对照组比较，研究组平均手术时间明显延长（113.92 min vs. 95.92 min，P=0.032），但结石残留率明显降低（0 vs. 6.0%，P=0.002），而术后住院时间无统计学差异（4.00 d vs. 5.11 d，P=0.088）；两组总并发症发生率无统计学差异（8.1% vs. 5.3%，P=0.701），观察组发生1例A级胆瘘与2例B级胆瘘，均经保守治疗治愈，两组均无中转开腹与死亡病例；均获至少12个月的随访，两组均无结石复发及有症状的胆道狭窄发生。
结论：对选择性病例实施一期缝合具有良好的短期与长期的临床效果。与T管引流术比较，一期缝合可改善患者生活质量，避免T管的使用的相关并发症。
关键词：
胆总管结石病；腹腔镜检查；胆总管造口术
方法：回顾性分析2013年6月—2016年9月南方医科大学附属佛山医院接受腹腔镜下胆总管探查取石患者临床资料，其中62例术中行一期缝合（研究组），38例行T管引流（对照组）。比较两组的相关临床指标。
结果：两组患者性别、BMI和胆总管直径无统计学差异（均P>0.05）；与对照组比较，研究组平均手术时间明显延长（113.92 min vs. 95.92 min，P=0.032），但结石残留率明显降低（0 vs. 6.0%，P=0.002），而术后住院时间无统计学差异（4.00 d vs. 5.11 d，P=0.088）；两组总并发症发生率无统计学差异（8.1% vs. 5.3%，P=0.701），观察组发生1例A级胆瘘与2例B级胆瘘，均经保守治疗治愈，两组均无中转开腹与死亡病例；均获至少12个月的随访，两组均无结石复发及有症状的胆道狭窄发生。
结论：对选择性病例实施一期缝合具有良好的短期与长期的临床效果。与T管引流术比较，一期缝合可改善患者生活质量，避免T管的使用的相关并发症。
Efficacy analysis of primary closure of common bile duct after laparoscopic common bile duct exploration
CorrespondingAuthor:LIAO Guanqun Email: drliaogq@qq.com
Abstract
Objective: To evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) with primary closure of the common bile duct.
Methods: The clinical data of patients undergoing LCBDE in Foshan Hospital affiliated to Southern Medical University from June 2013 to September 2016 were retrospectively analyzed. Of the patients, 62 cases received intraoperative primary closure of the common bile duct (study group), and 38 cases had T-tube drainage (control group). The main clinical variables between the two groups of patients were compared.
Results: There were no significant differences in gender, BMI and diameter of the common bile duct between the two groups of patients (all P>0.05). In study group compared with control group, the mean operative time was significantly prolonged (113.92 min vs. 95.92 min, P=0.032), but the residual stone rate was significantly reduced (0 vs. 6.0%, P=0.002), while the length of postoperative hospital stay showed no significant difference (4.00 d vs. 5.11 d, P=0.088). The overall incidence of postoperative complications showed no significant difference between the two groups (8.1 vs. 5.3%, P=0.701), and grade A and B biliary fistula occurred in one and two cases respectively in study group, which were all resolved by conservative treatment. No open conversion was required and on death occurred in either of the groups. Follow-up was performed in both groups of patients for at least 12 months, and no stone recurrence or symptomatic stricture of the common bile duct was noted.
Conclusion: In selected patients, LCBDE with primary closure of the common bile duct has favorable short- and long-term efficacy, and can improve the patients’ quality of life and avoid the complications associated with use of T-tube.
Keywords：
Choledocholithiasis; Laparoscopy; Choledochostomy
Methods: The clinical data of patients undergoing LCBDE in Foshan Hospital affiliated to Southern Medical University from June 2013 to September 2016 were retrospectively analyzed. Of the patients, 62 cases received intraoperative primary closure of the common bile duct (study group), and 38 cases had T-tube drainage (control group). The main clinical variables between the two groups of patients were compared.
Results: There were no significant differences in gender, BMI and diameter of the common bile duct between the two groups of patients (all P>0.05). In study group compared with control group, the mean operative time was significantly prolonged (113.92 min vs. 95.92 min, P=0.032), but the residual stone rate was significantly reduced (0 vs. 6.0%, P=0.002), while the length of postoperative hospital stay showed no significant difference (4.00 d vs. 5.11 d, P=0.088). The overall incidence of postoperative complications showed no significant difference between the two groups (8.1 vs. 5.3%, P=0.701), and grade A and B biliary fistula occurred in one and two cases respectively in study group, which were all resolved by conservative treatment. No open conversion was required and on death occurred in either of the groups. Follow-up was performed in both groups of patients for at least 12 months, and no stone recurrence or symptomatic stricture of the common bile duct was noted.
Conclusion: In selected patients, LCBDE with primary closure of the common bile duct has favorable short- and long-term efficacy, and can improve the patients’ quality of life and avoid the complications associated with use of T-tube.