腹腔镜胆总管探查治疗胆囊切除术后胆总管结石的临床效果
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摘要
目的探讨腹腔镜下胆总管探查(LCBDE)治疗胆囊切除术后胆总管结石的临床效果。方法回顾性分析2014年12月至2018年2月36例行LCBDE治疗的胆囊切除术后胆总管结石患者的临床资料。结果 36例患者中,成功完成LCBDE者32例(88.9%);3例因腹腔粘连分离困难,1例因胆总管下段结石嵌顿,均中转开腹。32例患者中,术中放置T管者28例,4例患者胆总管置8F双J导管并一期缝合;患者手术时间为(122.6±16.5)min,术中出血量为(48.6±11.7)mL,术后住院时间为(5.2±2.5)d;术后胆总管残留结石1例,于术后6周胆道镜经T管窦道取石治愈;胆总管一期缝合的4例患者于术后2周在门诊胃镜下取出留置双J导管。随访1～38个月,中位随访时间13个月,无反流性胆管炎、胆管狭窄,1例胆总管结石复发。结论LCBDE治疗胆囊切除术后胆总管结石安全有效,且患者创伤小、恢复快。
Objective To investigate the clinical efficacy of laparoscopic common bile duct exploration(LCBDE) in the treatment of choledocholithiasis after cholecystectomy. Methods The clinical data of 36 patients with choledocholithiasis after cholecystectomy undergoing LCBDE treatment from December 2014 to February 2018 were retrospectively analyzed. Results Of the 36 patients, LCBDE was successfully completed in 32 patients(88.9%). Three cases were converted to laparotomy because of abdominal adhesions and difficult separation, and one case because of incarcerating with lower common bile duct stones. Of the32 patients, 28 cases was given T-tube placement during operation, and 4 cases received 8 F double J catheter placement in common bile duct and primary suture. The operation time was(122.6±16.5) min, intraoperative blood loss was(48.6±11.7) mL,and postoperative hospital stay was(5.2±2.5) d. One case had residual choledocholithiasis after operation and was cured by choledochoscopic lithotripsy via T-tube sinus at 6 weeks after operation; four patients with primary suture of common bile duct underwent indwelling double J catheter removalunder outpatient gastroscope 2 weeks after operation. The patients we re followed-up for 1 to 38 months, with the median of 13 months. There were no reflux cholangitis and biliary stricture, and 1 case of recurrence of choledocholithiasis. Conclusion LCBDE is safe and effective in the treatment of choledocholithiasis after cholecystectomy, with less trauma and faster recovery.
Objective To investigate the clinical efficacy of laparoscopic common bile duct exploration(LCBDE) in the treatment of choledocholithiasis after cholecystectomy. Methods The clinical data of 36 patients with choledocholithiasis after cholecystectomy undergoing LCBDE treatment from December 2014 to February 2018 were retrospectively analyzed. Results Of the 36 patients, LCBDE was successfully completed in 32 patients(88.9%). Three cases were converted to laparotomy because of abdominal adhesions and difficult separation, and one case because of incarcerating with lower common bile duct stones. Of the32 patients, 28 cases was given T-tube placement during operation, and 4 cases received 8 F double J catheter placement in common bile duct and primary suture. The operation time was(122.6±16.5) min, intraoperative blood loss was(48.6±11.7) mL,and postoperative hospital stay was(5.2±2.5) d. One case had residual choledocholithiasis after operation and was cured by choledochoscopic lithotripsy via T-tube sinus at 6 weeks after operation; four patients with primary suture of common bile duct underwent indwelling double J catheter removalunder outpatient gastroscope 2 weeks after operation. The patients we re followed-up for 1 to 38 months, with the median of 13 months. There were no reflux cholangitis and biliary stricture, and 1 case of recurrence of choledocholithiasis. Conclusion LCBDE is safe and effective in the treatment of choledocholithiasis after cholecystectomy, with less trauma and faster recovery.
引文
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[8]杜军卫,靳君华,胡文秀,等.胆囊结石继发肝外胆管结石的三种术式比较[J].岭南现代临床外科,2017,97(4):276-279.
[9]金上博,刘益民,闫耀生,等.腹腔镜保胆取石术治疗胆囊结石继发胆总管结石的临床研究[J].腹腔镜外科杂志,2016,21(9):681-684.
[10]潘成文,吴育连.腹腔镜与开腹胆总管取石一期缝合的临床比较[J].中国微创外科杂志,2016,16(6):518-521.
[11]LEE JS,YOON YC.Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent[J].Surg Endosc,2016,30(6):2530-2534.
[2]陈流华,郑朝旭,谭敏,等.内镜超声检查在腹腔镜胆囊切除术前的价值[J].中华腔镜外科杂志:电子版,2010,3(1):50-52.
[3]胡晋太,蔡晚霞.警惕腹腔镜胆囊切除术后胆总管结石的遗漏[J].中国微创外科杂志,2012,12(2):171-172.
[4]吴孟超,吴在德.黄家驷外科学[M].7版.北京:人民卫生出版社,2008,1801-1802.
[5]刘泽良,朱建方,何伟,等.腹腔镜下胆道镜经胆囊管行胆道探查取石术的体会[J].腹部外科杂志,2015,28(4):283-286,297.
[6]YANG J,JIN H,GU W,et al.Determinants of long-term complications of endoscopic sphincterotomy are infections and high risk factors of bile duct and not sphincter of Oddi dysfunction[J].Eur J Gastroenterol Hepatol,2015,27(4):412-418.
[7]陆新良,梁廷波.EST治疗中Oddi括约肌功能的保护及意义[J].中国实用外科杂志,2017,37(8):48-50.
[8]杜军卫,靳君华,胡文秀,等.胆囊结石继发肝外胆管结石的三种术式比较[J].岭南现代临床外科,2017,97(4):276-279.
[9]金上博,刘益民,闫耀生,等.腹腔镜保胆取石术治疗胆囊结石继发胆总管结石的临床研究[J].腹腔镜外科杂志,2016,21(9):681-684.
[10]潘成文,吴育连.腹腔镜与开腹胆总管取石一期缝合的临床比较[J].中国微创外科杂志,2016,16(6):518-521.
[11]LEE JS,YOON YC.Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent[J].Surg Endosc,2016,30(6):2530-2534.