腹腔镜联合胆道镜胆总管切开取石一期缝合的临床应用
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摘要
目的探讨腹腔镜联合胆道镜胆总管切开取石一期缝合的可行性和安全性。方法将2016年6月～2018年8月河池市人民医院收治的行腹腔镜联合胆道镜胆总管切开取石的82例患者作研究对象,根据对胆总管切口的处理方法不同分为研究组和对照组,研究组40例,行胆总管一期缝合术,对照组42例,行T管引流术。比较两组的手术效果和并发症情况。结果两组患者均手术顺利,无中转开腹病例。研究组的手术时间、术中出血量、术后下床活动时间、拔除腹腔引流管时间、住院时间均低于对照组,但差异均无统计学意义(P>0.05)。研究组电解质紊乱的发生率、术后恢复工作时间、住院费用均低于对照组,差异有统计学意义(P<0.05)。研究组手术并发症的发生率均低于对照组,但差异无统计学意义(P>0.05)。结论腹腔镜联合胆道镜胆总管切开取石一期缝合治疗肝内外胆管结石,疗效好、恢复快、内环境紊乱少、住院费用低,是安全、可行的。
Objective To investigate the feasibility and safety of laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture. Methods 82 patients who underwent laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture from Hechi People's Hospital from June 2016 to August 2018 were enrolled as study objects. They were divided into study group and control group according to the different treatment methods of common bile duct incision. 40 patients in the study group underwent primary suture of the common bile duct and 42 patients in the control group underwent T-tube drainage. The surgical outcomes and complications of the 2 groups were compared. Results All the patients in the two groups were operated smoothly and there were no cases of conversion to open surgery. The operation time, intraoperative blood loss, postoperative ambulation time, time of removal of abdominal drainage tube, and hospitalization time were lower in the study group than those in the control group, but the difference was not statistically significant(P>0.05). The incidence of electrolyte disturbance, postoperative recovery time, and hospitalization cost in the study group were lower than those in the control group, and the difference was statistically significant(P<0.05). The incidence of surgical complications in the study group was lower than that in the control group, but the difference was not statistically significant(P>0.05). Conclusion Laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture in the treatment of intrahepatic and extrahepatic bile duct stones has good curative effect, rapid recovery, less internal environment disorder and low hospitalization cost. It is safe and feasible.
Objective To investigate the feasibility and safety of laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture. Methods 82 patients who underwent laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture from Hechi People's Hospital from June 2016 to August 2018 were enrolled as study objects. They were divided into study group and control group according to the different treatment methods of common bile duct incision. 40 patients in the study group underwent primary suture of the common bile duct and 42 patients in the control group underwent T-tube drainage. The surgical outcomes and complications of the 2 groups were compared. Results All the patients in the two groups were operated smoothly and there were no cases of conversion to open surgery. The operation time, intraoperative blood loss, postoperative ambulation time, time of removal of abdominal drainage tube, and hospitalization time were lower in the study group than those in the control group, but the difference was not statistically significant(P>0.05). The incidence of electrolyte disturbance, postoperative recovery time, and hospitalization cost in the study group were lower than those in the control group, and the difference was statistically significant(P<0.05). The incidence of surgical complications in the study group was lower than that in the control group, but the difference was not statistically significant(P>0.05). Conclusion Laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture in the treatment of intrahepatic and extrahepatic bile duct stones has good curative effect, rapid recovery, less internal environment disorder and low hospitalization cost. It is safe and feasible.
引文
[1]彭靖,马军亮,朱智辉,等.腹腔镜胆总管切开取石一期缝合术的体会[J].腹部外科,2016,29(5):353-359.
[2]游蓁,叶辉,陈利平,等.腹腔镜胆道探查术后胆总管一期缝合与T管引流的疗效比较[J].中国普外基础与临床杂志,2013,20(4):447-449.
[3]刘威,沈根海,高泉根,等.腹腔镜胆总管一期缝合术与T管引流术治疗肝外胆管结石的疗效比较[J].腹腔镜外科杂志,2016,21(7):543-546.
[4]马珂歆,梁锐,杨明,等.腹腔镜联合胆道镜胆总管探查术治疗胆管结石[J].中国普外基础与临床杂志,2013,20(5):562-564.
[5]杜振武.腹腔镜联合胆道镜胆总管切开取石Ⅰ期缝合术治疗胆总管结石效果分析[J].河南外科学杂志,2018,24(4):38-39.
[6]谷化剑,雷绍奎,喻超,等.腹腔镜胆道探查胆总管一期缝合术治疗胆管结石的疗效分析[J].腹部外科,2017,30(4):291-294.
[7]何少武,康俊升,吴波,等.腹腔镜胆总管探查取石术后胆管一期缝合的疗效观察[J].腹腔镜外科杂志,2018,23(8):606-608.
[8]Yin Z,Xu K,Sun J,et al.Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming A systematic review and meta-analysis[J].Ann Surg,2013,257(1):54-66.
[9]何耀鹏,焦文萍,邓睿,等.腹腔镜联合胆道镜胆总管切开取石一期缝合术治疗肝外胆管结石的临床效果[J].广西医科大学学报,2017,34(10):1502-1504.
[10]董桂银,喻宗繁,陈江明.双镜联合胆总管切开一期缝合治疗胆总管结石的临床体会[J].肝胆外科杂志,2017,25(8):262-264.
[11]李嘉兴,郭永学,王金重,等.腹腔镜联合硬性胆道镜胆总管切开取石一期缝合53例报告[J].实用临床医药杂志,2014,18(7):64-65.
[12]黄庆录,李鸿飞,黄客增,等.三镜联合体内冲击波碎石仪治疗嵌顿性胆管结石[J].临床外科杂志,2016,24(4):270-272.
[13]van Dijk AH,Lamberts M,van Laarhoven CJ,et al.Laparoscopy in cholecysto-choledocholithiasis[J].Best Pract Res Clin Gastroenterol,2014,28(1):195-209.
[14]吴鹏,方路,付小伟,等.单向倒刺线与普通可吸收线在腹腔镜下胆总管切开取石一期缝合术中应用的对比研究[J].中国内镜杂志,2016,22(9):52-56.
[15]刘东斌,刘家峰,徐大华,等.腹腔镜胆总管探查一期缝合术并发症及治疗策略[J].腹腔镜外科杂志,2015,20(11):855-858.
[16]Cai H,Sun D,Sun Y,et al.Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy[J].World J Surg,2012,6(1):164-170.
[17]冯林松,郁林海,顾春飞,等.经脐入路腹腔镜胆总管探查一期缝合术后胆漏34例分析[J].肝胆胰外科杂志,2014,26(4):268-271.
[18]王家兴,林龙英,李捷,等.腹腔镜下胆道一期缝合的临床分析[J].腹腔镜外科杂志,2017,22(6):433-436.
[19]张志强,肖占军,冯秋实.内镜下胆道内支架置入引流治疗囊型肝包虫病术后胆漏的疗效[J].腹部外科,2018,31(2):108-111.
[20]张淼,谈永飞.腹腔镜下经胆囊管胆总管探查术与胆总管探查并一期缝合术治疗胆总管结石的对比研究[J].中国普通外科杂志,2017,26(2):151-156.
[21]姚晶,李鸿.胆总管探查一期缝合术291例经验探讨[J].中国医学创新,2012,22(9):87-88.
[22]陈杰,严栋梁,袁岱岳,等.胆总管直径≤1 cm的患者行腹腔镜胆总管探查一期缝合术中应用J形胆道支架的体会[J].腹腔镜外科杂志,2018,23(3):203-206.
[23]Zhou CG,Wei BJ,Wang JF,et al.Percutaneous transhepatic biliary drainage combined with balloon dilatation in treatment of benign biliary-enteric anastomotic strictures[J].Chin J Interv Imaging Ther,2016,13(9):521-525.
[24]杨强,张爱民,陈晓燕,等.胆道术后胆道良性狭窄17例临床分析[J].腹部外科,2018,31(1):48-51.
[2]游蓁,叶辉,陈利平,等.腹腔镜胆道探查术后胆总管一期缝合与T管引流的疗效比较[J].中国普外基础与临床杂志,2013,20(4):447-449.
[3]刘威,沈根海,高泉根,等.腹腔镜胆总管一期缝合术与T管引流术治疗肝外胆管结石的疗效比较[J].腹腔镜外科杂志,2016,21(7):543-546.
[4]马珂歆,梁锐,杨明,等.腹腔镜联合胆道镜胆总管探查术治疗胆管结石[J].中国普外基础与临床杂志,2013,20(5):562-564.
[5]杜振武.腹腔镜联合胆道镜胆总管切开取石Ⅰ期缝合术治疗胆总管结石效果分析[J].河南外科学杂志,2018,24(4):38-39.
[6]谷化剑,雷绍奎,喻超,等.腹腔镜胆道探查胆总管一期缝合术治疗胆管结石的疗效分析[J].腹部外科,2017,30(4):291-294.
[7]何少武,康俊升,吴波,等.腹腔镜胆总管探查取石术后胆管一期缝合的疗效观察[J].腹腔镜外科杂志,2018,23(8):606-608.
[8]Yin Z,Xu K,Sun J,et al.Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming A systematic review and meta-analysis[J].Ann Surg,2013,257(1):54-66.
[9]何耀鹏,焦文萍,邓睿,等.腹腔镜联合胆道镜胆总管切开取石一期缝合术治疗肝外胆管结石的临床效果[J].广西医科大学学报,2017,34(10):1502-1504.
[10]董桂银,喻宗繁,陈江明.双镜联合胆总管切开一期缝合治疗胆总管结石的临床体会[J].肝胆外科杂志,2017,25(8):262-264.
[11]李嘉兴,郭永学,王金重,等.腹腔镜联合硬性胆道镜胆总管切开取石一期缝合53例报告[J].实用临床医药杂志,2014,18(7):64-65.
[12]黄庆录,李鸿飞,黄客增,等.三镜联合体内冲击波碎石仪治疗嵌顿性胆管结石[J].临床外科杂志,2016,24(4):270-272.
[13]van Dijk AH,Lamberts M,van Laarhoven CJ,et al.Laparoscopy in cholecysto-choledocholithiasis[J].Best Pract Res Clin Gastroenterol,2014,28(1):195-209.
[14]吴鹏,方路,付小伟,等.单向倒刺线与普通可吸收线在腹腔镜下胆总管切开取石一期缝合术中应用的对比研究[J].中国内镜杂志,2016,22(9):52-56.
[15]刘东斌,刘家峰,徐大华,等.腹腔镜胆总管探查一期缝合术并发症及治疗策略[J].腹腔镜外科杂志,2015,20(11):855-858.
[16]Cai H,Sun D,Sun Y,et al.Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy[J].World J Surg,2012,6(1):164-170.
[17]冯林松,郁林海,顾春飞,等.经脐入路腹腔镜胆总管探查一期缝合术后胆漏34例分析[J].肝胆胰外科杂志,2014,26(4):268-271.
[18]王家兴,林龙英,李捷,等.腹腔镜下胆道一期缝合的临床分析[J].腹腔镜外科杂志,2017,22(6):433-436.
[19]张志强,肖占军,冯秋实.内镜下胆道内支架置入引流治疗囊型肝包虫病术后胆漏的疗效[J].腹部外科,2018,31(2):108-111.
[20]张淼,谈永飞.腹腔镜下经胆囊管胆总管探查术与胆总管探查并一期缝合术治疗胆总管结石的对比研究[J].中国普通外科杂志,2017,26(2):151-156.
[21]姚晶,李鸿.胆总管探查一期缝合术291例经验探讨[J].中国医学创新,2012,22(9):87-88.
[22]陈杰,严栋梁,袁岱岳,等.胆总管直径≤1 cm的患者行腹腔镜胆总管探查一期缝合术中应用J形胆道支架的体会[J].腹腔镜外科杂志,2018,23(3):203-206.
[23]Zhou CG,Wei BJ,Wang JF,et al.Percutaneous transhepatic biliary drainage combined with balloon dilatation in treatment of benign biliary-enteric anastomotic strictures[J].Chin J Interv Imaging Ther,2016,13(9):521-525.
[24]杨强,张爱民,陈晓燕,等.胆道术后胆道良性狭窄17例临床分析[J].腹部外科,2018,31(1):48-51.