切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 530 -533. doi: 10.3877/cma.j.issn.1674-3946.2020.05.027

所属专题: 文献

论著

两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析
练远书1, 黄高1,(), 陆开艺1, 文明波1   
  1. 1. 541002 桂林,解放军联勤保障部队第九二四医院肝胆胰外科
  • 收稿日期:2019-08-26 出版日期:2020-10-26
  • 通信作者: 黄高

A comparative study of LCBDE and LBEPS in the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter

Yuanshu Lian1, Gao Huang1,(), Kaiyi Lu1, Mingbo Wen1   

  1. 1. Hepatobiliary and Pancreatic Surgery, 924 Hospital of Joint Logistics Support Force of PLA, Guilin 541002, Chian
  • Received:2019-08-26 Published:2020-10-26
  • Corresponding author: Gao Huang
  • About author:
    Corresponding author: Huang Gao, Email:
引用本文:

练远书, 黄高, 陆开艺, 文明波. 两种手术方法对胆总管直径≥1.0 cm结石患者的疗效分析[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(05): 530-533.

Yuanshu Lian, Gao Huang, Kaiyi Lu, Mingbo Wen. A comparative study of LCBDE and LBEPS in the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 530-533.

目的

探究腹腔镜胆总管切开探查取石并T管外引流术(LCBDE)与腹腔镜胆总管切开探查取石并一期缝合术(LBEPS)对胆总管直径≥1.0 cm结石患者的治疗效果。

方法

回顾性分析2015年1月至2019年1月胆总管直径≥1.0 cm结石患者100例资料,按不同术式分为LCBDE组52例、LBEPS组48例。采用SPSS20.0统计软件进行分析处理。术中术后各项指标、胆管压力、生活质量、应激反应比较采用(±s)描述,独立样本t检验;术后并发症、取石成功率、结石残余率、复发率比较采用χ2检验,P<0.05为具有统计学意义。

结果

LBEPS组患者引流时间、下床活动时间、可进食时间、胃肠道功能恢复时间、住院时间均少于LCBDE组(P<0.05)。术后LBEPS组患者生活质量评分高于LCBDE组,胆管压力低于LCBDE组(P<0.05)。LBEPS组患者术后应激反应程度低于LCBDE组(P<0.05)。LCBDS组患者取石成功率高于LCBDE组,结石残余率、复发率均低于LBEPE组,但两组比较差异无统计学意义(P>0.05)。LBEPS组患者术后并发症发生率为3.9%(2/52)低于LCBDE组18.8%(9/48),P<0.05。

结论

LBEPS治疗胆总管直径≥1.0cm结石可促进患者术后快速恢复,减少患者手术机体应激反应,取石成功率较高,且术后并发症发生率较低,安全性较高。

Objective

To study the effect of laparoscopic common bile duct exploration with T tube drainage (LCBDE) and laparoscopic common bile duct exploration with primary suture(LBEPS) for the treatment of choledocholithiasis with ≥1.0 cm common bile duct diameter.

Methods

From January 2015 to January 2019, 100 patients with calculi of common bile duct diameter ≥1.0 cm admitted to our hospital were retrospectively analyzed. According to different operative methods, 52 patients were divided into LCBDE group and 48 patients were divided into LBEPS group. SPSS20.0 statistical software was used for analysis. Intraoperative and postoperative indicators, bile duct pressure, quality of life, and stress response were described by (±s), and compared with independent t test. χ2 test was used to compare postoperative complications, success rate of stone extraction, residual stone rate and recurrence rate. P<0.05 was considered statistically significant.

Results

Patients in the LBEPS group had shorter drainage time, activity time, feeding time, recovery time of gastrointestinal function and hospitalization time than those in the LCBDE group (P<0.05). Postoperative quality of life score in LBEPS group was higher than that in LCBDE group, and bile duct pressure was lower than that of LCBDE group (P<0.05). The degree of postoperative stress response in the LBEPS group was lower than that in the LCBDE group (P<0.05). The success rate of stone extraction in the LCBDS group was higher than that in the LCBDE group, and the residual and recurrence rates of stones were lower than those in the LBEPE group, but there was no statistical difference between the two groups (P>0.05). The incidence of postoperative complications in the LBEPS group was 3.9% (2/52), which was lower than that in the LCBDE group (18.8% (9/48) (P<0.05).

Conclusion

LBEPS for the treatment of calculi with the diameter of common bile duct ≥1.0 cm can promote the rapid recovery of patients after surgery, reduce the stress response of patients during surgery, and achieve a high success rate of stone extraction, as well as a low incidence of postoperative complications and high safety.

表1 100例胆总管结石患者不同术式两组基线资料比较[(±s),例]
表2 100例胆总管结石患者不同术式两组患者临床指标比较[(±s), d]
表3 100例胆总管结石患者不同术式两组患者术前、术后胆管压力、生活质量比较(±s)
表4 100例胆总管结石患者不同术式两组患者手术前后机体应激反应比较(±s)
表5 100例胆总管结石患者不同术式两组患者取石成功率、结石残余率、复发率比较[例(%)]
表6 100例胆总管结石患者不同术式两组术后并发症发生情况比较(例)
[1]
Lv SD,Fang ZP,Wang A,et al.Choledochoscopic Holmium Laser Lithotripsy for Difficult Bile Duct Stones[J].J Laparoendosc Adv Surg Tech A,2017,27(1):24-27.
[2]
Enliang L,Rongshou W,Shidai S,et al.Simple resection of the lesion bile duct branch for treatment of regional hepatic bile duct stones[J].Medicine (Baltimore),2017,96(27):e7414.
[3]
刘子旭,曹迁,凌晓锋.肝内胆管结石病治疗进展[J].实用医学杂志,2016,32(4):513-515.
[4]
何慧菊.腹腔镜胆与开腹胆总管切开取石临床疗效对比研究[J].肝胆外科杂志,2018,26(6):440-442.
[5]
Li KY,Shi CX,Tang KL,et al.Advantages of laparoscopic common bile duct exploration in common bile duct stones[J].Wien Klin Wochenschr,2018,130(3-4):100-104.
[6]
燕涛,侯亚峰,程晓剑,等.腹腔镜胆囊切除及胆总管切开取石并T管引流术对胆囊并胆总管结石患者血清Na+K+水平及安全性的影响[J].河北医学,2017,23(6):975-977.
[7]
Zhan XL,Wang YD,Zhu JH,et al.Laparoscopic Choledocholithotomy With a Novel Articulating Forceps[J].Surg Innov,2016,23(2):124-129.
[8]
李红军,赵静,段仁全,等.腹腔镜胆总管探查术后胆总管一期缝合与T管引流的疗效观察[J].中国普外基础与临床杂志,2016,23(7):873-875.
[9]
刘刚,孔胜兵,詹志林,等.双镜联合胆总管切开探查后胆总管一期缝合与T管引流的对比研究[J].肝胆外科杂志,2018,26(6):446-449.
[10]
Jie Z,Hong L,Shaocheng Z,et al.A study of primary single and layered suture technique by using two-port laparoscopic choledocholithotomy[J].J Minim Access Surg,2019,15(4):311-315.
[11]
Lee JS,Yoon YC.Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent[J].Surg Endosc,2016,30(6):2530-2634.
[12]
Parra-Membrives P,Martínez-Baena D,Lorente-Herce J,et al.Comparative Study of Three Bile Duct Closure Methods Following Laparoscopic Common Bile Duct Exploration for Choledocholithiasis[J].J Laparoendosc Adv Surg Tech A,2018,28(2):145-151.
[13]
Hori T.Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation[J].World J Gastroenterol,2019,25(13):1531-1549.
[14]
梁永任,黄燕金,梁日光,等.LBEPS与LCTD治疗胆总管结石的临床对比研究[J].中国医药导报,2013,10(20):51-53,57.
[15]
钟家国,赵劲松,杨汉勇,等.LBEPS术中一期缝合与T管引流的临床效果比较[J].西南国防医药,2017,27(7):719-721.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[11] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[12] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要