Zheng Y M, Liu D B, Wang Y H, Liu J F, Liu L W, Bai X S, Li F
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
The First Clinical Medical College, Capital Medical University, Beijing 100053, China.
Zhonghua Wai Ke Za Zhi. 2019 Apr 1;57(4):282-287. doi: 10.3760/cma.j.issn.0529-5815.2019.04.008.
To explore the selection method and technology of laparoscopic surgery for gallbladder stones and common bile duct stones(GCBDS). Data was collected from 318 in-patients of GCBDS at Department of General Surgery,Xuanwu Hospital of Capital Medical University from January 2013 to December 2017, and 298 in-patients acceptedlaparoscopic cholecystectomy(LC) and choledocholithotomy were recruited into final analysis.There were 138 males and 160 females,aged (60.4±18.6)years (range:25-89 years).Retrospective analysis was done on method distribution,effect and safety of laproscopic surgery.Comparisons of basic characters and therapeutic effects were performed betweenlaparoscopic common bile duct exploration (LCBDE) combined with primary closure and T tube drainage(TTD). Among therecruited in-patients,LC combined with common bile duct exploration was performed in 7 cases(2.3%, 7/298), LC combined with LCBDE was performed in 291 cases(97.7%,291/298).There were 133 cases (45.7%,133/291) who treated by LCBDE combined with TTD and 158 cases(54.3%,158/291) who treated by LCBDE combined with primary closure.In LCBDE combined with primary closure group,18 cases (11.4%,18/158)had intraoperative biliary manometry.All patients were followed up for 6 months at least and there no death.Postoperative complications rate was 10.0% (29/291).There were no significant differences in sex ratio,age,American Society of Anesthesiologists score,concomitant diseases and previous abdominal surgery history between LCBDE combined with primary closure and LCBDE combined with TTD group.Patients in LCBDE combined with primary closure group were accompanied with less acute cholangitis than TTD group (43.3% .76.7%; χ(2)=9.061, 0.002).There were no significant differences in the diameter of common bile duct, the number of stones, hospitalization expenses and the incidence of complications between the two groups(all 0.05).LCBDE combined with primary closure had shorter operation time ((134.2±28.3)minutes .(148.3±19.6)minutes; -1.830, 0.011)and post-operative hospitalization time ((5.6±2.6)days . (7.2±2.4)days; -1.847,0.014).Bile duct leakage rate was higher in primary closure group(6.3% .0.8%, χ(2)=3.934, 0.047) and TTD group had higher residual stones rate(6.8% .1.3%; χ(2)=6.008, 0.014). Strategy for treating GCBDS by laparoscopic surgery should be considered preoperative evaluation and intraoperative exploration to select appropriate minimally invasive surgical methods and techniques.
探讨胆囊结石合并胆总管结石（GCBDS）的腹腔镜手术选择方法及技术。收集2013年1月至2017年12月首都医科大学宣武医院普通外科318例GCBDS住院患者资料，最终纳入298例行腹腔镜胆囊切除术（LC）及胆总管切开取石术的住院患者。其中男性138例，女性160例，年龄（60.4±18.6）岁（范围：25 - 89岁）。对腹腔镜手术的方法分布、效果及安全性进行回顾性分析。比较腹腔镜胆总管探查（LCBDE）联合一期缝合与T管引流（TTD）的基本特征及治疗效果。在所纳入的住院患者中，LC联合胆总管探查7例（2.3%，7/298），LC联合LCBDE 291例（97.7%，291/298）。LCBDE联合TTD治疗133例（45.7%，133/291），LCBDE联合一期缝合治疗158例（54.3%，158/291）。LCBDE联合一期缝合组中，18例（11.4%，18/158）行术中胆道测压。所有患者至少随访6个月，无死亡病例。术后并发症发生率为10.0%（29/291）。LCBDE联合一期缝合组与LCBDE联合TTD组在性别比例、年龄、美国麻醉医师协会评分、合并疾病及既往腹部手术史方面无显著差异。LCBDE联合一期缝合组急性胆管炎发生率低于TTD组（43.3%对76.7%；χ² = 9.061，P = 0.002）。两组在胆总管直径、结石数量、住院费用及并发症发生率方面均无显著差异（均P＞0.05）。LCBDE联合一期缝合手术时间较短（（134.2±28.3）分钟对（148.3±19.6）分钟；t = -1.830，P = 0.011），术后住院时间也较短（（5.6±2.6）天对（7.2±2.4）天；t = -1.847，P = 0.014）。一期缝合组胆漏发生率较高（6.3%对0.8%，χ² = 3.934，P = 0.047），TTD组残余结石发生率较高（6.8%对1.3%；χ² = 6.008，P = 0.014）。腹腔镜手术治疗GCBDS的策略应综合术前评估及术中探查，选择合适的微创手术方法及技术。
Zhonghua Wai Ke Za Zhi. 2019-4-1
Cochrane Database Syst Rev. 2013-9-3
J Laparoendosc Adv Surg Tech A. 2005-6
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