Comparison of laparoscopic choledocholithiasis in the treatment of choledocholithiasis

doi:10.3877/cma.j.issn.1674-3946.2021.06.030

Abstract

Abstract:

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.

Key words: Choledocholithiasis, Laparoscopes, T-tube drainage, Primary suture

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.

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References 20

[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，2020，29(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，2020，33(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，2020，11(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，2020，26(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，2020，25(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，2020，26(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，2020，40(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)，2020，17(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，2020，42(1)：24-26，30.

组别	例	年龄(岁)	性别	BMI(kg/m²)
组别	例	年龄(岁)	男/女	BMI(kg/m²)
T管组	40	65.3±7.9	27/13	22.5±5.6
缝合组	40	65.1±7.8	26/14	22.2±5.2
t/χ²值		0.652	0.059	0.376
P值		0.518	0.638	0.328
组别	例	胆总管直径(cm)	胆总管结石数	总胆红素(μmol/L)
T管组	40	2.2±0.8	2.7±0.6	23.7±2.6
缝合组	40	2.1±0.8	2.6±0.6	23.2±2.4
t/χ²值		0.562	0.523	0.612
P值		0.476	0.412	0.538

组别	例	年龄(岁)	性别	BMI(kg/m²)
组别	例	年龄(岁)	男/女	BMI(kg/m²)
T管组	40	65.3±7.9	27/13	22.5±5.6
缝合组	40	65.1±7.8	26/14	22.2±5.2
t/χ²值		0.652	0.059	0.376
P值		0.518	0.638	0.328
组别	例	胆总管直径(cm)	胆总管结石数	总胆红素(μmol/L)
T管组	40	2.2±0.8	2.7±0.6	23.7±2.6
缝合组	40	2.1±0.8	2.6±0.6	23.2±2.4
t/χ²值		0.562	0.523	0.612
P值		0.476	0.412	0.538

组别	例	手术时间(min)	胆总管缝合时间(min)	术中出血量(ml)	疼痛评分
T管组	40	116.8±14.8	22.7±6.2	31.5±5.2	3.8±0.8
缝合组	40	89.6±12.7	13.3±4.6	31.2±5.1	1.5±0.5
t值		12.785	10.398	0.765	12.667
P值		0.003	0.028	0.551	0.007
组别	例	镇痛药使用次数	排气时间(d)	肠道功能恢复时间(d)	住院时间(d)
T管组	40	1.6±0.7	2.9±0.7	3.0±0.6	9.8±1.3
缝合组	40	0.5±0.3	2.1±0.6	2.4±0.5	7.2±1.2
t值		7.358	8.277	7.295	8.563
P值		0.047	0.003	0.023	0.031

组别	例	手术时间(min)	胆总管缝合时间(min)	术中出血量(ml)	疼痛评分
T管组	40	116.8±14.8	22.7±6.2	31.5±5.2	3.8±0.8
缝合组	40	89.6±12.7	13.3±4.6	31.2±5.1	1.5±0.5
t值		12.785	10.398	0.765	12.667
P值		0.003	0.028	0.551	0.007
组别	例	镇痛药使用次数	排气时间(d)	肠道功能恢复时间(d)	住院时间(d)
T管组	40	1.6±0.7	2.9±0.7	3.0±0.6	9.8±1.3
缝合组	40	0.5±0.3	2.1±0.6	2.4±0.5	7.2±1.2
t值		7.358	8.277	7.295	8.563
P值		0.047	0.003	0.023	0.031

组别	例	胆道出血	胆瘘	胆道感染	胆道狭窄	结石残留	结石复发	其他
T管组	40	1(2.5)	2(5.0)	2(5.0)	1(2.5)	1(2.5)	2(5.0)	9(22.5)
缝合组	40	1(2.5)	1(2.5)	1(2.5)	1(2.5)	1(2.5)	1(2.5)	6(15.0)
χ²值		0	0.346	0.346	0	0	0.346	0.738
P值		1.000	0.976	0.976	1.000	1.000	0.976	0.687

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