摘要
目的:探讨多次胆道手术后再行腹腔镜胆总管探查(LCBDE)的安全性及有效性。方法:回顾分析2014年1月至2021年6月收治的胆总管探查术后胆总管结石复发的249例患者的临床资料,按照手术方式分为LCBDE组(n=96)与内镜十二指肠乳头括约肌切开术(EST)组(n=153),比较两组手术相关指标、术后并发症及结石复发率等。结果:249例患者均顺利完成手术,无中转手术及死亡病例。LCBDE组与EST组结石残余(3 vs.8)、胃肠道通气时间[均为1(1,2)d]、术后总胆红素下降[7.4(-1.6,43.2)μmol/L vs.2.9(0.3,11.0)μmol/L]、术后谷丙转氨酶下降[31.5(-2.8,127.5)U/L vs.17(1,58.5)U/L]、胆漏例数(1 vs.0)差异均无统计学意义(P>0.05),住院时间[(7.3±2.1)d vs.(9.1±4.0)d]、术中出血量[50(20,50)mL vs.0(0,0)mL]及结石复发(6 vs.24)、胰腺炎(0 vs.10)、胆管炎(0 vs.8)、胆道出血(0 vs.7)情况差异均有统计学意义(P<0.05)。结论:对于有胆道探查史的胆总管结石复发患者,LCBDE与EST在安全性、治疗效果方面均可靠,相较EST,LCBDE的优势主要体现在住院时间更短、术后并发症发生率与术后结石复发率更低等方面,临床上可作为治疗的首选。但如果患者因高龄、营养状态差、合并多种基础疾病等其他因素不能耐受常规外科手术,选择EST更合适。
Objective:To explore the safety and efficacy of laparoscopic common bile duct exploration(LCBDE)after multiple biliary tract operations.Methods:The clinical data of 249 patients with recurrent common bile duct stones treated from Jan.2014 to Jun.2021 after common bile duct exploration were reviewed and analyzed.Patients were divided into the LCBDE group(n=96)and the endoscopic sphincterotomy(EST)group(n=153)according to the operation method,and the relevant operation indexes,postoperative complications and stone recurrence rate of the two groups were compared.Results:All 249 patients underwent the operation successfully,and no conversion to laparotomy or death occurred.No statistically significant differences were observed in the number of residual calculi(3vs.8),gastrointestinal ventilation time[1(1,2)d vs.1(1,2)d],the postoperative total bilirubin decline[7.4(-1.6,43.2)μmol/L vs.2.9(0.3,11.0)μmol/L],postoperative ALT decrease[31.5(-2.8,127.5)U/L vs.17(1,58.5)U/L],bile leakage(1 vs.0)between the LCBDE group and the EST group.Compared with the EST group,the LCBDE group was associated with shorter hospital stay[(7.3±2.1)d vs.(9.1±4.0)d],more intraoperative blood loss[50(20,50)mL vs.0(0,0)mL],fewer cases of stone recurrence(6 vs.24),pancreatitis(0 vs.10),cholangitis(0 vs.8)and bile duct bleeding(0 vs.7),and the differences were statistically significant(P<0.05).Conclusions:For patients with recurrent choledocholithiasis who have a history of biliary exploration,LCBDE and EST are both reliable in terms of safety and therapeutic effect.Compared with EST,LCBDE has the advantages of shorter hospital stay,lower incidence of postoperative complications and recurrence of postoperative calculi,and should be the first choice for clinical treatment.However,if patients cannot tolerate routine surgery due to old age,poor nutritional status,and multiple basic diseases,it will be more appropriate to choose EST.
作者
陈博文
王怡
司亚卿
CHEN Bo-wen;WANG Yi;SI Ya-qing(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《腹腔镜外科杂志》
2023年第5期349-354,共6页
Journal of Laparoscopic Surgery
关键词
胆总管结石病
胆总管探查
腹腔镜检查
括约肌切开术
内窥镜
胆道术后
Choledocholithiasis
Common bile duct exploration
Laparoscopy
Sphincterotomy,endoscopic
After biliary surgery
