腹腔镜胆总管切开取石一期缝合的临床应用研究

Clinical application of choledocholithotomy and primary suture in treatment of choledocholithiasis

摘要:

摘要：目的 探讨腹腔镜胆总管切开取石一期缝合的安全性及可行性。方法 回顾性分析2014年8月－2017年8月解放军总院海南分院肝胆外科58例腹腔镜胆总管切开取石患者的临床资料，根据胆总管切口不同处理方式分为一期缝合组30例和留置T管组28例，观察两组手术时间、术后住院时间和术后并发症等指标。结果 一期缝合组30例，患者术后发生2例胆漏，留置T管组28例，患者术后发生2例胆漏，1例结石残留，两组均未发生胆道狭窄。两组患者的手术时间和手术并发症发生率比较，差异均无统计学意义（P >0.05）；一期缝合组的术后住院时间和术后恢复工作时间均明显短于留置T管组，两组比较，差异均有统计学意义（P <0.05）。结论 在严格掌握手术适应证的前提下，腹腔镜胆总管切开取石术一期缝合是安全可行的，体现出微创外科技术的优越性。

Abstract:

Abstract: Objective To evaluate the feasibility and safety of primary suture in laparoscopic common bile duct exploration for treating choledocholithiasis. Methods The clinical data in 58 cases of choledocholithiasis underwent laparoscopic common bile duct exploration from Aug 2014 to Aug 2017 were retrospectively analyzed. The patients were divided into laparoscopic common bile duct exploration and primary suture group (n = 30) and T-tube drainage group (n = 28) according to different processing modes of common bile duct incision. The operation time, postoperative hospital stays and complications were analyzed and compared. Results Bile leakage occurred in 2 cases in the primary suture group and in the T-tube drainage group, residual stones occurred 1 case in the T-tube drainage group, no biliary stricture was found in either groups. The time of operation, postoperative complications were not statistically different (P > 0.05). The difference in postoperative hospital stay and function recovery time between the two groups was statistically significant (P < 0.05). Conclusion In well selected cases, the primary suture of common bile duct after laparoscopic choledocholithotomy is feasible and safe, embody the advantages of minimally invasive surgery.