腹腔镜下不同入路的胆总管探查术治疗胆总管结石的临床疗效
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摘要
目的:比较腹腔镜胆囊切除术(LC)联合不同入路的腹腔镜胆总管探查术后一期缝合治疗胆囊结石合并胆总管结石患者的疗效,以评价和探讨各种腹腔镜胆总管探查术入路的优劣和临床价值。方法:回顾性分析接受腹腔镜胆囊切除术联合不同入路的腹腔镜胆总管探查术后一期缝合治疗的67例胆囊结石合并胆总管结石患者的临床资料。根据手术方式分为LC联合经胆囊管汇入部微切开入路的腹腔镜胆总管探查术组(LC+TC-LCBDE,n=28)和LC联合经胆总管切开入路的腹腔镜胆总管探查术组(LC+TD-LCBDE,n=39),比较2组患者的手术时间、术中出血量、术后住院时间、腹腔引流时间、术后并发症以及术后随访结果。结果:LC+TC-LCBDE组腹腔引流时间为(3.11±1.53)d,少于LC+TD-LCBDE组的(3.96±1.83) d(P<0.05),LC+TC-LCBDE组术后住院时间为(5.47±0.95) d,少于LC+TD-LCBDE组的(6.52±1.64) d(P<0.05)。2组患者术后并发症无明显差异(P>0.05)。结论:LC联合经胆囊管汇入部微切开入路的腹腔镜胆总管探查术效果好,并发症少,患者恢复快,值得临床推广。
Objective:To evaluate and discuss the advantages and disadvantages and clinical value of different approaches to laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy in the treatment of cholecysto-choledocholithiasis(CCL). Methods:A retrospective review of clinical data of 67 patients with CCL who received different approaches to laparoscopic common bile duct exploration with primary closure combined with laparoscopic cholecystectomy in Heping Hospital Affiliated to Changzhi Medical College from September 2016 to November 2018 was performed. All patients were divided into laparoscopic trans-cystic common bile duct exploration(through the mini-incision in the joint of CBD and cystic duct) combined with laparoscopic cholecystectomy(LC+TC-LCBDE, n=28) and laparoscopic trans-choledochal common bile duct exploration(LC+TD-LCBDE, n=39) according to different surgical approaches. The operation time, intraoperative blood loss, postoperative hospital stay, abdominal drainage time and postoperative complications were compared between the two groups. All patients were followed up after discharge. Results: Compared with the LC+TD-LCBDE group, there were fewer operation time, intraoperative blood loss, abdominal drainage time, and postoperative hospital stay in the LC+TC-LCBDE group. The difference in abdominal drainage time and postoperative hospital stay was statistically significant( P<0.05). There was no significant difference in postoperative complications between the two groups(P >0.05). Conclusion: Laparoscopic trans-cystic common bile duct exploration(through the mini-incision in the joint of CBD and cystic duct) combined with laparoscopic cholecystectomy(LC+TC-LCBDE) is more minimally invasive, safe and effective and is superior to laparoscopic trans-choledochal common bile duct exploration(LC+TD-LCBDE) in the treatment of cholecysto-choledocholithiasis(CCL).
Objective:To evaluate and discuss the advantages and disadvantages and clinical value of different approaches to laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy in the treatment of cholecysto-choledocholithiasis(CCL). Methods:A retrospective review of clinical data of 67 patients with CCL who received different approaches to laparoscopic common bile duct exploration with primary closure combined with laparoscopic cholecystectomy in Heping Hospital Affiliated to Changzhi Medical College from September 2016 to November 2018 was performed. All patients were divided into laparoscopic trans-cystic common bile duct exploration(through the mini-incision in the joint of CBD and cystic duct) combined with laparoscopic cholecystectomy(LC+TC-LCBDE, n=28) and laparoscopic trans-choledochal common bile duct exploration(LC+TD-LCBDE, n=39) according to different surgical approaches. The operation time, intraoperative blood loss, postoperative hospital stay, abdominal drainage time and postoperative complications were compared between the two groups. All patients were followed up after discharge. Results: Compared with the LC+TD-LCBDE group, there were fewer operation time, intraoperative blood loss, abdominal drainage time, and postoperative hospital stay in the LC+TC-LCBDE group. The difference in abdominal drainage time and postoperative hospital stay was statistically significant( P<0.05). There was no significant difference in postoperative complications between the two groups(P >0.05). Conclusion: Laparoscopic trans-cystic common bile duct exploration(through the mini-incision in the joint of CBD and cystic duct) combined with laparoscopic cholecystectomy(LC+TC-LCBDE) is more minimally invasive, safe and effective and is superior to laparoscopic trans-choledochal common bile duct exploration(LC+TD-LCBDE) in the treatment of cholecysto-choledocholithiasis(CCL).
引文
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[7]Shakya JPS,Agrawal N,Kumar A,et al. Primary closure versus T-tube drainage after laparoscopic choledocholithotomy:a prospective randomized study[J]. Int Surg J,2017,4(5):1762.
[8]Yi HJ,Hong G,Min SK,et al. Long-term Outcome of Primary Closure After Laparoscopic Common Bile Duct Exploration Combined With Choledochoscopy[J]. Surgical Laparoscopy Endoscopy&Percutaneous Techniques,2015,25(3):250-253.
[9]Zi Y,Kang X,Jian S,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[M]. Centre for Reviews and Dissemination(UK),2013:54-66.
[10]Wen SQ,Hu QH,Wan M,et al. Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration[J]. Digestive Diseases&Sciences,2017,62(5):1-6.
[11]陈剑,韦军民.术中微切开胆道镜检查的可行性研究[J].中华肝胆外科杂志,2005,11(6):372-374.
[12]缪刚,李尧,陈剑,等.微切开取石治疗胆管结石的优越性[J].中华肝胆外科杂志,2012,18(9):668-670.
[13]罗昆仑,方征,余锋,等.腹腔镜经胆囊管开口微切开胆管并一期缝合胆管治疗胆囊结石合并胆管结石[J].中华肝胆外科杂志,2013,19(5):349-351.
[14]彭颖,王立新,徐智,等.腹腔镜联合胆道镜经胆囊管汇入部微切开治疗胆囊结石合并胆总管结石[J].中国微创外科杂志,2015,15(3):224-227.
[2]张雷达,王曙光,别平,等.不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究[J].中国内镜杂志,2006,12(5):474-477.
[3]Hanif F,Ahmed Z,Samie MA,et al. Laparoscopic transcystic bile duct exploration:the treatment of first choice for common bile duct stones[J]. Surgical Endoscopy,2010,24(7):1552-1556.
[4]Dasari BV,Tan CJ,Gurusamy KS,et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev,2013,12:CD003327.
[5]董家鸿.胆道微创治疗必须高度重视Oddi括约肌的保护[J].中华消化外科杂志,2012,11(5):405-407.
[6]刘永锋,李桂臣.胆道外科不容忽视的两个问题—Oddi括约肌功能保护与胆管末段损伤防治[J].中国实用外科杂志,2013(5):348-350.
[7]Shakya JPS,Agrawal N,Kumar A,et al. Primary closure versus T-tube drainage after laparoscopic choledocholithotomy:a prospective randomized study[J]. Int Surg J,2017,4(5):1762.
[8]Yi HJ,Hong G,Min SK,et al. Long-term Outcome of Primary Closure After Laparoscopic Common Bile Duct Exploration Combined With Choledochoscopy[J]. Surgical Laparoscopy Endoscopy&Percutaneous Techniques,2015,25(3):250-253.
[9]Zi Y,Kang X,Jian S,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[M]. Centre for Reviews and Dissemination(UK),2013:54-66.
[10]Wen SQ,Hu QH,Wan M,et al. Appropriate Patient Selection Is Essential for the Success of Primary Closure After Laparoscopic Common Bile Duct Exploration[J]. Digestive Diseases&Sciences,2017,62(5):1-6.
[11]陈剑,韦军民.术中微切开胆道镜检查的可行性研究[J].中华肝胆外科杂志,2005,11(6):372-374.
[12]缪刚,李尧,陈剑,等.微切开取石治疗胆管结石的优越性[J].中华肝胆外科杂志,2012,18(9):668-670.
[13]罗昆仑,方征,余锋,等.腹腔镜经胆囊管开口微切开胆管并一期缝合胆管治疗胆囊结石合并胆管结石[J].中华肝胆外科杂志,2013,19(5):349-351.
[14]彭颖,王立新,徐智,等.腹腔镜联合胆道镜经胆囊管汇入部微切开治疗胆囊结石合并胆总管结石[J].中国微创外科杂志,2015,15(3):224-227.