腹腔镜胆总管探查术后一期缝合的疗效观察

Clinical observation of primary closure after laparoscopic common bile duct exploration

摘要:

目的 探讨腹腔镜胆总管探查术（LCBDE）后一期缝合治疗合并急性胆管炎的胆总管结石患者的安全性和可行性。方法 回顾性分析2015年1月－2020年8月合肥市第二人民医院108例在LCBDE后行一期缝合患者的临床资料。根据术前患者有无急性胆管炎分为有胆管炎组和无胆管炎组，对两组患者手术时间、术中出血量、术后拔管时间、术后住院时间和术后并发症等资料进行比较分析。结果 两组患者均成功完成手术，无中转开腹病例，与无胆管炎组相比，有胆管炎组术中出血量较多，差异有统计学意义（P = 0.010），两组患者手术时间、术后拔管时间、术后住院时间比较，差异均无统计学意义（P > 0.05）；两组患者术后并发症发生率比较，差异无统计学意义（P > 0.05）。结论 在遵循相关手术适应证的前提下，LCBDE后一期缝合治疗合并急性胆管炎的胆总管结石是安全可行的。

Abstract:

Objective To investigate the safety and feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE) for patients with choledocholithiasis complicated with acute cholangitis.Methods The clinical data of 108 patients who underwent primary closure after LCBDE from January 2015 to August 2020 were retrospectively analyzed. Patients were divided into two groups according to the presence or absence of acute cholangitis before operation. The operative time, intraoperative blood loss, postoperative extubation time, postoperative hospital stay and postoperative complications were compared and analyzed between the two groups.Results Laparoscopic surgery was successfully completed in both groups, and no patient was transferred to laparotomy. Compared with the group without cholangitis, the intraoperative blood loss was more than that in the group with cholangitis (P = 0.010), and the difference was statistically significant. There was no significant difference between the two groups in operative time, postoperative extubation time, postoperative hospitalization time (P > 0.05). There was also no significant difference in the incidence of postoperative complications between the two groups (P > 0.05).Conclusion Under the premise of following the relevant surgical indications, primary closure after LCBDE is safe and feasible in the treatment of patients with choledocholithiasis complicated with acute cholangitis.