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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 314 -316. doi: 10.3877/cma.j.issn.1674-3946.2019.03.031

所属专题： 文献；

论著

双镜联合治疗胆总管结石胆总管一期缝合的临床研究
肖家全1, 张勇1,†()   
  1. 1. 243000　安徽，马鞍山市人民医院普外二科
  • 收稿日期:2018-10-16 出版日期:2019-06-26
  • 通信作者: 张勇

Clinical study of primary closure of common bile duct of laparoscopy combined with choledochoscope in the treatment of common bile duct stones

Jiaquan Xiao1, Yong Zhang1,†()   

  1. 1. Department of General Surgery, Ma an shan People’s hospital, An hui Ma an shan, 243000, China
  • Received:2018-10-16 Published:2019-06-26
  • Corresponding author: Yong Zhang
  • About author:
    Corresponding author: Zhang Yong, Email:
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引用本文：

肖家全, 张勇. 双镜联合治疗胆总管结石胆总管一期缝合的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(03): 314-316.

Jiaquan Xiao, Yong Zhang. Clinical study of primary closure of common bile duct of laparoscopy combined with choledochoscope in the treatment of common bile duct stones[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(03): 314-316.

目的

探讨腹腔镜联合胆道镜治疗胆总管结石胆总管一期缝合临床应用价值。

方法

回顾性分析2015年7月至2017年10月84例胆总管结石患者的病历资料，按手术方式的不同分为A组(27例，行腹腔镜联合胆道镜胆囊切除＋胆总管切开取石＋胆总管一期缝合术)、B组(29例，行腹腔镜联合胆道镜胆囊切除＋胆总管切开取石＋T管引流术)和C组(28例，传统的开腹胆囊切除＋胆总管切开取石＋T管引流术)。应用SPSS 22.0统计软件分析数据，一般资料和手术相关指标等计量资料以均数±标准差表示，采用F检验；手术后并发症等采用χ2检验。P<0.05为差异有统计学意义。

结果

A组的出血量及术后住院时间均明显低于B组和C组，A组胃肠功能恢复时间明显低于C组，差异均有统计学意义(P<0.05)。各组手术后并发症总发生率比较，差异无统计学意义(P>0.05)。

结论

在把握胆总管一期缝合的手术指征及具备熟练的腹腔镜、胆道镜操作技能下，对于胆囊结石合并胆总管结石患者，腹腔镜联合胆道镜双镜联合下行胆囊切除＋胆总管切开取石＋胆总管一期缝合术是安全可行的。

关键词: 胆总管结石, 腹腔镜, 缝合技术
Objective

To investigate the clinical value of primary closure of common bile duct of laparoscopy combined with choledochoscope in the treatment of common bile duct stones.

Methods

A retrospective analysis of 84 patients with choledocholithiasis from July 2015 to October 2017 was made. According to the different surgical methods, they were divided into group A (27 cases, received laparoscopic cholecystectomy combined with choledochoscopy and choledocholithotomy and primary suture of common bile duct) and group B (29 cases, received laparoscopic cholecystectomy combined with choledochoscopy and choledocholithotomy and T tube drainage) and group C (28 cases, received traditional open cholecystectomy and choledocholithotomy and T tube drainage). The clinical data was analyzed by SPSS 22.0 statistical software, the general data and operation-related indicators were expressed as mean-standard deviation, and examined by F test. The postoperative complications were examined by chi-square test. P<0.05 was statistically significant.

Results

The amount of bleeding and postoperative hospitalization time in group A were significantly lower than those in group B and C, and the recovery time of gastrointestinal function in group A was significantly lower than that in group C (P<0.05). There was no significant difference in the incidence of postoperative complications in all groups (P>0.05).

Conclusion

It is safe and feasible for patients with cholecystolithiasis and choledocholithiasis to undergo cholecystectomy, choledocholithotomy and primary closure of common bile duct by laparoscopy combined with choledochoscope under the guidance of primary suture of common bile duct and skilled laparoscopy and choledochoscopy.

Key words: Choledocholithiasis, Laparoscopes, Suture techniques
表1 84例胆总管结石患者不同术式各组患者一般资料比较(±s)
组别 例数 男/女(例) 年龄(岁) 发病时间(h)
A组 27 11/16 57.4±15.4 65.4±13.4
B组 29 12/17 56.1±17.3 70.0±16.2
C组 28 11/17 57.9±16.3 69.6±14.3
χ2/F ? χ2＝0.027 F＝0.092 F＝0.826
P ? 0.987 0.912 0.442
表2 84例胆总管结石患者不同术式各组患者手术相关指标对比情况(±s)
组别 例数 手术时间(min) 出血量(ml) 术后住院时间(min) 胃肠功能恢复时间(min)
A组 27 162.7±56.0 15.9±11.5 8.7±2.5 3.0±0.9
B组 29 167.5±86.3 41.7±45.4a 11.8±4.0a 3.6±1.5
C组 28 137.4±42.2 42.9±24.5a 11.7±3.7a 4.5±1.3a
表3 84例胆总管结石患者不同术式各组患者手术后并发症比较(例)
组别 例数 胆漏 胆道狭窄 切口感染 结石残留 电解质紊乱 总发生率(%)
A组 27 2 1 0 0 0 3(11.1)
B组 29 1 0 1 0 2 4(13.8)
C组 28 1 0 2 1 1 5(17.9)
χ2 ? ? ? ? ? ? 0.520
P ? ? ? ? ? ? 0.771
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