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) ›› 2021, Vol. 15 ›› Issue (06) : 693 -695. doi: 10.3877/cma.j.issn.1674-3946.2021.06.030

论著

腹腔镜胆总管探查治疗胆总管结石胆管闭合方式的选取比较
马良丰1,(), 马召峰1   
  1. 1. 236800 亳州市中医院普外科
  • 收稿日期:2020-10-15 出版日期:2021-12-26
  • 通信作者: 马良丰

Comparison of laparoscopic choledocholithiasis in the treatment of choledocholithiasis

Liangfeng Ma1,(), Zhaofeng Ma1   

  1. 1. General Surgery, Bozhou Chinese Medicine Hospital, Anhui 236800, China
  • Received:2020-10-15 Published:2021-12-26
  • Corresponding author: Liangfeng Ma
  • Supported by:
    Anhui Health and Family Planning Commission Scientific Research Project(2016QK085)
引用本文:

马良丰, 马召峰. 腹腔镜胆总管探查治疗胆总管结石胆管闭合方式的选取比较[J]. 中华普外科手术学杂志(电子版), 2021, 15(06): 693-695.

Liangfeng Ma, Zhaofeng Ma. Comparison of laparoscopic choledocholithiasis in the treatment of choledocholithiasis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(06): 693-695.

目的

探讨和比较腹腔镜胆总管探查治疗胆总管结石胆管闭合方式的选取。

方法

回顾性分析2015年1月至2020年6月收治并予以腹腔镜胆总管探查治疗胆总管结石的患者80例,其中40例患者予以传统的胆总管T管引流(T管组),40例患者予以胆总管一期缝合(缝合组)。采用SPSS 21.0统计分析软件进行分析,两组患者围术期指标等计量资料以(±s)表示,采用独立样本t检验;两组患者结石残留、结石复发等并发症发生率采用χ2检验。P<0.05为差异具有统计学意义。

结果

缝合组患者手术时间、胆总管缝合时间、术后疼痛评分、术后镇痛药使用次数、排气时间、肠道功能恢复时间和住院时间均小于T管组,差异有统计学意义(P<0.05);两组患者术后胆道出血、胆瘘、胆道感染、胆道狭窄、结石残留、结石复发等并发症发生率差异无统计学意义(P>0.05)。

结论

腹腔镜胆总管探查治疗胆总管结石采用一期缝合具有良好的治疗效果,且不增加患者治疗后并发症发生率。

Objective

To explore and compare the selection of closure methods in the treatment of common bile duct stones.

Methods

80 patients treated by laparoscopic common bile duct exploration were retrospectively analyzed from January 2015 to June 2020. including 40 patients who received traditional T-tube drainage (T-tube group), and 40 patients were treated with primary suture (primary suture group). SPSS 21.0 statistical analysis software was used for analysis. Perioperative indicators and other measurement data of the two groups were expressed by (±s) and independent sample t test was used; the incidence of complications such as residual stones and stone recurrence were analyzed by χ 2 test. P<0.05 was considered statistically significant.

Results

The operation time, common bile duct suture time, postoperative pain score, the number of postoperative analgesic needle use, exhaust time, intestinal function recovery time and hospitalization time in the primary suture group were less than those in the T-tube group, and the difference was statistically significant (P<0.05); the amount of intraoperative bleeding, postoperative biliary bleeding, bile leakage, biliary tract infection, biliary stricture, residual stones, stone recurrence, etc. in the two groups There was no significant difference in the incidence of complications (P>0.05).

Conclusion

Laparoscopic common bile duct exploration in the treatment of choledocholithiasis with one-stage suture has a good therapeutic effect, and does not increase the incidence of postoperative complications.

表1 80例胆总管结石不同术式两组患者一般临床资料比较(±s)
表2 80例胆总管结石不同术式两组患者围术期指标比较(±s)
表3 80例胆总管结石不同术式两组患者术后并发症发生情况比较[例(%)]
[1]
Park S, Kim SG. Recurrence of choledocholithiasis following laparoscopic common bile duct exploration: a multicenter study and recurrent common bile duct stones[J]. HPB, 2019, 21(18) : S329-S330.
[2]
赵元勋,吴先麟,张成,等. 腹腔镜胆总管探查术后一期缝合联合鼻胆管引流的疗效分析[J]. 局解手术学杂志202029(6):491-494.
[3]
Yao C, Tian Y, Yao D, et al. T-tube-free single-incision laparoscopic common bile duct exploration plus cholecystectomy: a single centre experience[J]. ANZ J Surg, 2019, 89(7-8) : 895-899.
[4]
魏耕富,马智,权力,等. 腹腔镜胆囊切除术、胆总管切开取石术联合胆总管一期缝合术治疗胆管结石的临床效果[J]. 临床误诊误治202033(6):52-56.
[5]
Muhammedoglu B. Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography[J]. Surg Laparosc Endosc Percutan Tech, 2019, 29(5) : 399-404.
[6]
陈英男,李勇,陈凡旗,等. 胆总管结石腹腔镜胆总管探查术后三种胆管闭合方法的对比研究[J]. 中国临床实用医学202011(2):28-32.
[7]
Ali I, Khalid S, Stieger B, et al. Effect of a Common Genetic Variant (p.V444A) in the Bile Salt Export Pump on the Inhibition of Bile Acid Transport by Cholestatic Medications[J]. Mol Pharm, 2019, 16(3) : 1406-1411.
[8]
邢人伟,聂寒秋,张阳,等. 老年患者腹腔镜胆总管一期缝合与留置T管治疗胆囊结石合并胆总管结石的比较分析[J]. 中国内镜杂志202026(6):25-29.
[9]
Lee HW, Park DH, Lee JH, et al. Prevalence and Predictors of Unnecessary Endoscopic Retrograde Cholangiopancreatography in the Two-Stage Endoscopic Stone Extraction Followed by Laparoscopic Cholecystectomy[J]. J Gastrointest Surg, 2019, 23(8) : 1578-1588.
[10]
徐垚,安东均,冯金鸽,等. 胆总管探查一期缝合鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石的临床研究[J]. 腹腔镜外科杂志202025(4):288-292.
[11]
Jagtap N, Hs Y, Tandan M, et al. Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy[J]. Endoscopy, 2020, 52(7) : 569-573.
[12]
依布拉音江·马木提. 腹腔镜胆总管切开探查术后一期缝合治疗胆总管结石的临床研究[D]. 乌鲁木齐:新疆医科大学,2020:1-29.
[13]
vanSonnenberg E, Panchanathan R. Percutaneous Transcholecystic Management of Choledocholithiasis: A Next Horizon for Interventional Radiologists?[J]. Radiology, 2019, 290(1) : 244-245.
[14]
张胜龙,陈安平,索运生,等. 腹腔镜胆总管一期缝合联合经腹置入鼻胆管在术后胆漏预防中的作用[J]. 中华肝胆外科杂志202026(2):100-102.
[15]
Wang C-C, Tsai M-C, Wang Y-T, et al. Role of Cholecystectomy in Choledocholithiasis Patients Underwent Endoscopic Retrograde Cholangiopancreatography[J]. Sci Rep, 2019, 9(1) : 2168.
[16]
彭则男,廖启成,谢星,等. 腹腔镜下胆总管探查取石术后一期缝合的研究进展[J]. 赣南医学院学报202040(2):188-192,211.
[17]
Gee KM, Jones RE, Casson C, et al. More Is Less: The Advantages of Performing Concurrent Laparoscopic Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography for Pediatric Choledocholithiasis[J]. J Laparoendosc Adv Surg Tech A, 2019, 29(11) :1481-1485.
[18]
邓中波,严俊,阮贵林,等. 腹腔镜下胆管一期缝合与T管引流治疗肝外胆管结石的疗效对比及对IL-6及CRP水平的影响[J]. 湖南师范大学学报(医学版)202017(1):91-94.
[19]
Papanikolas M, Sarkar A, Bassan M, et al. Laparoscopic trans-gastric endoscopic retrograde cholangiopancreatography during emergent cholecystectomy after Roux-en-Y gastric bypass: novel techniques for choledocholithiasis[J]. ANZ J Surg, 2019, 90(5) : 912-914.
[20]
胡浩,李会星,赵玮,等. 腹腔镜经胆囊管胆总管汇合部切开取石一期缝合的临床应用研究[J]. 内蒙古医科大学学报202042(1):24-26,30.
[1] 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.
[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] 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.
[4] 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.
[5] 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.
[6] 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.
[7] 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.
[8] 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.
[9] 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.
[10] 唐健雄, 李绍杰. 不断推进中国腹腔镜疝手术规范化[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 591-594.
[11] 田文, 杨晓冬. 腹腔镜腹股沟疝修补术式选择及注意事项[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 595-597.
[12] 李涛, 陈纲, 李世拥. 腹腔镜下右侧腹股沟斜疝修补术(TAPP)[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 598-598.
[13] 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.
[14] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[15] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
阅读次数
全文


摘要