文章摘要

不留置T管引流治疗胆囊结石并胆总管结石的临床疗效

作者: 1尹飞飞, 1李学民, 1段希斌, 1王忠振, 1李连涛, 1杨鹏生, 1梁马可, 2孙世波
1 郑州大学附属郑州中心医院 肝胆胰外科，河南 郑州 450007
2 哈尔滨医科大学附属第二医院 普通外科，黑龙江 哈尔滨150001
通讯: 李学民 Email: zzlxm@msn.com
DOI: 10.3978/.10.3978/j.issn.1005-6947.2016.08.004
基金: 河南省郑州市普通科技攻关资助项目, 20150043

摘要

目的：探讨不留置T管引流治疗胆囊结石合并胆总管结石的临床疗效。方法：回顾性分析2013年9月—2014年9月收治的100例胆囊结石合并胆总管结石患者的临床资料，其中45例行腹腔镜胆囊切除（LC）+胆总管探查胆道一期缝合术（一期缝合术组），55例行LC+经内镜下十二指肠乳头括约肌切开术（括约肌切开术组）；所有患者随访12~24个月。对比分析两组患者的相关临床资料。结果：两组术前年龄、性别、胆红素、转氨酶及胆管结石直径差异均无统计学意义（均P>0.05），但一期缝合术组胆总管扩张直径明显大于括约肌切开术组（P<0.05）。100例均顺利完成手术、术后痊愈出院。两组患者术后第1天均可下床活动，手术时间、总住院时间、结石残余情况差异均无统计学意义（均P>0.05）；但一期缝合术组术中出血量、术后禁食水时间、术后住院时间、住院费用均少于括约肌切开术组（均P<0.05）；并发症方面，一期缝合术组术后胆汁漏5例，括约肌切开术组术后急性胰腺炎6例，差异有统计学意义（均P<0.05）。结论：不留置T管引流的腹腔镜胆总管探查胆道一期缝合术，可保留Oddi括约肌功能、避免长期留置T管，更显微创技术优势，是一种有效、可行的术式，值得临床应用。
关键词： 胆囊结石病 胆总管结石 腹腔镜 胆道外科手术

Clinical efficacy of T-tube-free approach in treatment of gallbladder stones and concomitant common bile duct stones

Authors: 1YIN Feifei, 1LI Xuemin, 1DUAN Xibin, 1WANG Zhongzhen, 1LI Liantao, 1YANG Pengsheng, 1LIANG Make, 2SUN Shibo
1 Department of Hepatopancreatobiliary Surgery, Affiliated Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou 450007, China
2 Department of General Surgery, the Second Affiliated Hospital, Harbin Medical Univerisity, Harbin 150001, China

CorrespondingAuthor:LI Xuemin Email: zzlxm@msn.com

Abstract

Objective: To investigate the clinical efficacy of T-tube-free approach in treatment of patients with gallbladder stones and concomitant common bile duct (CBD) stones. Methods: The clinical data of 100 patients with gallbladder stones and CBD stones treated during September 2013 to September 2014 were retrospectively studied. Of the patients, 45 cases underwent laparoscopic cholecystectomy (LC), common bile duct exploration and primary suture (primary closure group), and 55 cases were subjected to LC and endoscopic sphincterotomy (sphincterotomy group). All patients were followed-up for 12–24 months. The relevant clinical variables between the two groups were compared and analyzed. Results: There was no statistical difference in gender, age, bilirubin and transaminase levels and mean diameter of the CBD stones between the two groups (all P>0.05), but the mean diameter of the dilated CBD in primary closure group was significantly larger than that in sphincterotomy group (P<0.05). All the 100 patients successfully underwent operation and were discharged after recovery. In all patients, ambulation was resumed on postoperative day one, and no statistical difference was noted in operative time, total length of hospital stay and remnant stones (all P>0.05), but the intraoperative blood loss, time to postoperative food and water consumption, length of postoperative stay and hospitalization costs were all reduced in primary closure group compared with sphincterotomy group (all P<0.05). As for complications, postoperative bile leakage occurred in 5 cases in primary closure group, and postoperative acute pancreatitis occurred in 6 cases in sphincterotomy group, and both differences had statistical significance (both P<0.05). Conclusion: Laparoscopic common bile duct exploration and primary suture without T-tube drainage can preserve the function of sphincter of Oddi and avoid long-term T-tube placement, which shows the benefits of the minimally invasive techniques, and it is an effective and feasible approach worthy of clinical use.
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