切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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
[1]
宋浩，刘志苏．胆总管探查取石后一期缝合术的临床探讨[J]．中华普通外科杂志，2017, 24(1)：1065-1066.
[2]
Lv F, Zhang S, Ji M, et al. Single－stage management with combined tri－endoscopic approach for concomitant cholecystolithiasis and choledocholithiasis[J]. Surg Endosc, 2016, 30(12): 5615-5620.
[3]
Awsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration: 15－year experience in a district general hospital[J]. Surg Endosc, 2016, 30(6): 2563-2566.
[4]
黄振添，谢昭雄，陈佳佳，等．腹腔镜联合胆道镜胆总管切开取石胆总管一期缝合的临床应用[J/CD]．中华肝脏外科手术学电子杂志，2015, 4(6)：344-347.
[5]
梁廷波，白雪莉，陈伟．腹腔镜胆总管探查术治疗胆总管结石的现状与进展[J]．中华消化外科杂志，2018, 17(1)：22-25.
[6]
张宗明，苑海明，张舯．双镜联合同期治疗胆囊结石合并胆总管结石的策略[J]．中华消化外科杂志，2015, 14(4)：280-283.
[7]
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.
[8]
汪建初，浦涧，王存川，等．胆总管探查引流术后T管窦道形成的相关因素分析[J]．中华消化外科杂志，2015, 14(2)：141-144.
[9]
梁玉河，徐均伟，杨晓军．腹腔镜胆总管探查术后一期缝合留置经皮肝穿刺胆道引流管的临床研究[J]. 腹腔镜外科杂志，2017, 22(9)：673-676.
[10]
Podda M, POJignano FM, Luhmann A, et al.Systematic review with meta－analysis of studies comparing primary duct closure and T－tube drainage after laparoscopic common bile duct exploration for choledocholithiasis[J]. Surg Endosc, 2016, 30(3): 845-861.
[11]
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.
[12]
Xu Y, Dong C, Ma K, et al. Spontaneously removed biliary stent drainage versus T－tube drainage after laparoscopic common bile duct exploration[J]. Medicine, 2016, 95(39): e5011-e5011.
[13]
于安星，吴承先，刘哲．腹腔镜胆总管切开一期缝合术后胆漏的原因及处理方法[J]. 中华肝胆外科杂志，2016, 22(7)：490-492.
[14]
张胜龙，陈安平，李华林，等．经腹与经口鼻胆管引流在腹腔镜手术中的应用比较[J]．中华肝胆外科杂志，2016, 22(8)：534-536.
[15]
赵传庆，吴保安，吴波，等．腹腔镜胆总管探查取石一期缝合治疗胆总管结石42例临床分析[J]．中华普通外科杂志，2017, 32(6)：530-531.
[1] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[4] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[5] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[6] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[7] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[8] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[9] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[10] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[11] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[12] 刘跃刚, 薛振峰. 腹腔镜腹股沟疝日间手术在老年患者中的安全性分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 711-714.
[13] 田静, 方秀春. 超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 740-744.
[14] 李雪, 刘文婷, 窦丽婷, 刘叶红. 联合护理在腹腔镜食管裂孔疝修补中的应用效果分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 750-754.
[15] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号