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腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析
Clinical effect of primary duct closure in laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration among patients with gallstones complicated by common bile duct stones
文章发布日期:2018年02月07日  来源:  作者:杨彦,林师佈,韩霖,等  点击次数:589次  下载次数:65次

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【摘要】:目的探讨腹腔镜联合胆道镜胆总管探查一期缝合术的安全性和有效性。方法回顾性分析2015年7月-2017年7月海南医学院第一附属医院肝胆胰外科收治的76例胆囊结石合并胆总管结石患者,分别行腹腔镜胆囊切除+胆道镜胆总管探查术+一期缝合(PDC组)(n=20)和腹腔镜胆囊切除+胆道镜胆总管探查术+T管引流(TTD组)(n=56),观察2组患者的手术时间、术中出血量、术后胃肠道功能恢复时间、腹腔引流管拔除时间、术后住院天数以及并发症(胆总管残余结石、胆瘘和胆道感染)发生率。术后随访2~12个月。计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验。结果所有患者均成功实施腹腔镜手术,无1例中转开腹。PDC组和TTD组患者在手术时间[(106.2±15.8)min vs (147.5±23.2)min]、术后胃肠道功能恢复时间[(32.9±8.1)h vs (49.4±6.5)h]、腹腔引流管拔管时间[(3.5±1.3)d vs (5.7±2.6)d]、术后住院时间[(6.3±1.5)d vs (11.4±2.0)d]进行比较,差异均有统计学意义(t值分别为-2.87、-3.61、-2.64、-26.34,P值分别为0.036、0.021、0.034、<0001)。2组患者术中出血、术后胆瘘、胆道残余结石和胆道感染方面差异均无统计学意义(P值均>005)。结论从有限病例进行初步研究发现,只要选择合适的病例,腹腔镜胆总管探查一期缝合术是安全有效的。
【Abstract】:ObjectiveTo investigate the clinical effect and safety of primary duct closure (PDC) in laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE). MethodsA retrospective analysis was performed for 76 patients with gallstones complicated by common bile duct stones who were admitted to Department of Hepatobiliary and Pancreatic Surgery in The First Affiliated Hospital of Hainan Medical University from July 2015 to July 2017, and among these patients, 20 underwent LC+LCBDE+PDC (PDC group) and 56 underwent LC+LCBDE+T-tube drainage (TTD) (TTD group). The two groups were observed and compared in terms of time of operation, intraoperative blood loss, time to gastrointestinal functional recovery after surgery, time to extraction of abdominal drainage tube, length of postoperative hospital stay, and incidence rates of related complications (residual common bile duct stones, biliary fistula, and biliary tract infection). The patients were followed up for 2-12 months after surgery. The t-test was used for comparison of continuous data between groups; the chi-square test was used for comparison of categorical data between groups. ResultsAll patients underwent a successful laparoscopic surgery, and no patient was converted to open surgery. There were significant differences between the PDC group and the TTD group in time of operation (106.2±15.8 min vs 147.5±23.2 min, t=-2.87, P=0.036), time to gastrointestinal functional recovery after surgery (32.9±8.1 h vs 49.4±6.5 h, t=-3.61, P=0.021), time to extraction of abdominal drainage tube (3.5±1.3 d vs 5.7±2.6 d, t=-2.64, P=0.034), and length of postoperative hospital stay (6.3±1.5 d vs 11.4±2.0 d, t=-26.34, P<0.001). There were no significant differences between the two groups in intraoperative blood loss, postoperative biliary fistula, residual bile duct stones, and biliary tract infection (all P>0.05). ConclusionA preliminary study of limited cases in our hospital shows that if patients are suitable, PDC is safe and effective in LC and LCBDE.
【关键字】:胆结石; 腹腔镜检查; 引流术
【Key words】:cholelithiasis; laparoscopy; drainage
【引证本文】:YANG Y, LIN SB, HAN L, et al. Clinical effect of primary duct closure in laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration among patients with gallstones complicated by common bile duct stones[J]. J Clin Hepatol, 2018, 34(3): 526-530. (in Chinese)
杨彦, 林师佈, 韩霖, 等. 腹腔镜联合胆道镜胆总管探查一期缝合术治疗胆囊结石合并胆总管结石的临床效果分析[J]. 临床肝胆病杂志, 2018, 34(3): 526-530.

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