腹腔镜下经胆囊管汇合部微切开一期缝合治疗非扩张性胆总管结石OA
Laparoscopic Micro-incision at the Cystic Duct Confluence with Primary Closure for Non-Dilated Common Bile Duct Stones
目的:探讨腹腔镜下经胆囊管汇合部微切开一期缝合治疗非扩张性胆总管结石合并胆囊结石的临床疗效与安全性.方法:回顾分析2021年1月1日至2023年12月31日在我院行腹腔镜下胆道胆总管切开取石的患者,根据术中处理方式不同分为微切开一期缝合组(观察组,n=49)和T管引流组(对照组,n=51).比较两组患者基线资料、围术期指标、术前术后肝功能指标、术后并发症及随访情况.结果:两组患者基线资料差异均无统计学意义(均P＞0.05).在手术操作时间、术后胃肠功能恢复时间、术后卧床时间、术后温氏孔引流管留置时间、总住院时间、住院总费用、术后第3天ALT、术后电解质紊乱发生率、切口炎性反应发生率、患者完全接受率方面,两组差异存在统计学意义(P＜0.05).两组术后随访12个月均未出现结石复发及胆道狭窄(P＞0.05).观察组出现胆漏4例,对照组出现1例,均经积极通畅引流治愈.另外,两组在术中出血量、术后第3天AST、术后第3天总胆红素、胆道出血率、结石残余率方面,差异无统计学意义(P＞0.05).结论:腹腔镜下经胆囊管汇合部微切开一期缝合治疗非扩张性胆总管结石合并胆囊结石术后恢复快、术后并发症少、生活质量高、安全、有效.
Objective To explore the clinical efficacy and safety of laparoscopic micro-incision at the cystic duct confluence with primary closure in the treatment of non-dilated common bile duct stones combined with gallbladder stones.Methods A retrospective analysis was conducted on patients who underwent laparoscopic choledocholithotomy at the Renmin Hospital,Hubei University of Medicine from January 1,2021,to December 31,2023.Patients were divided into an observation group(primary closure for micro-incision,n=49)and a(T-tube drainage,n=51)based on the surgical procedure.Baseline characteristics,perioperative outcomes,preoperative and postoperative liver function parameters,postoperative complications,and follow-up results were compared between the two groups.ResultsNo differences were found in baseline characteristics between the two groups(all P＞0.05).The observation group demonstrated significant advantages over the control group in terms of operation time,time to recovery of gastrointestinal function,duration of postoperative bed rest,du-ration of postoperative drainage at the foramen of Winslow,length of hospital stay,hospitalization costs,alanine amin-otransferase(ALT)on postoperative day 3,incidence of postoperative electrolyte disturbances,incidence of incisional in-flammation,and complete acceptance rate(all P＜0.05).During the 12-month follow-up,there were no recurrences of stones or biliary strictures noted in either group(P＞0.05).Bile leakage occurred in 4 patients in the observation group and in 1 patient in the control group,all of which were effectively managed with adequate drainage.Additionally,no differences were observed between the two groups regarding intraoperative blood loss,aspartate aminotransferase(AST)and total bili-rubin on postoperative day 3,incidence of biliary hemorrhage,or residual stone rates(all P＞0.05).Conclusion It is ef-fective and safe to perform laparoscopic micro-incision at the cystic duct confluence with primary closure for non-dilated common bile duct stones combined with gallbladder stones,which provides faster recovery,fewer complications,and im-proved quality of life.
刘坤;涂华华;封彦青;刘洋
湖北医药学院附属人民医院肝胆胰腺外科,湖北十堰 442000湖北医药学院附属人民医院肝胆胰腺外科,湖北十堰 442000湖北医药学院附属人民医院肝胆胰腺外科,湖北十堰 442000湖北医药学院附属人民医院肝胆胰腺外科,湖北十堰 442000
腹腔镜胆囊管胆总管汇合部微切开胆道探查一期缝合T管引流
LaparoscopyMicro-incision at cystic duct confluenceBiliary explorationPrimary closureT-tube drainage
《湖北医药学院学报》 2026 (2)
184-190,7
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