Department of Hepatological Surgery, Tongling People's Hospital, Anhui, China.
Turk J Gastroenterol. 2023 Jan;34(1):35-42. doi: 10.5152/tjg.2022.22110.
Background: Various surgical methods are available for cholecystolithiasis plus choledocholithiasis. The objective of this study is to explore the association between laparoscopic methods and clinical outcomes of cholecystolithiasis plus choledocholithiasis.
This cohort study retrospectively included patients who underwent laparoscopic surgery for cholecystolithiasis plus choledocholithiasis at our hospital (January 2017 to March 2021). The primary outcome was bile leakage.
Totally 127 patients were enrolled. The time to get out of bed and the indwelling duration of the abdominal drainage tube in the patients who underwent laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage were higher than the endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy group, without differences in the laparoscopic common bile duct exploration group (all P < .05). All indexes decreased in the 3 groups after surgery (all P < .01). On the first day after surgery, only white blood cells (P < .001) and gamma-glutamyl transferase (P = .045) showed significant differences among the different surgical methods. The incidence of biliary leakage (P = .001) was higher in laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, while the occurrence of hyperamylasemia was higher with endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy (P = .001). Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with fewer bile leakage (RR = 0.03, 95% CI: 0.003-0.37).
Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with bile leakage.
各种手术方法均可用于治疗胆囊结石合并胆总管结石。本研究旨在探讨腹腔镜方法与胆囊结石合并胆总管结石临床结局的关系。
本队列研究回顾性纳入我院（2017 年 1 月至 2021 年 3 月）接受腹腔镜胆囊结石合并胆总管结石手术的患者。主要结局是胆漏。
共纳入 127 例患者。腹腔镜胆囊切除术+胆总管切开取石+胆总管一期缝合+内镜鼻胆管引流患者下床时间和腹腔引流管留置时间均高于内镜逆行胰胆管造影+腹腔镜胆囊切除术组，腹腔镜胆总管探查组差异无统计学意义（均 P<.05）。3 组术后各指标均降低（均 P<.01）。术后第 1 天，仅白细胞（P<.001）和γ-谷氨酰转移酶（P=.045）在不同手术方法之间存在显著差异。腹腔镜胆囊切除术+胆总管切开取石+胆总管一期缝合+内镜鼻胆管引流胆漏发生率较高（P=.001），而内镜逆行胰胆管造影+腹腔镜胆囊切除术组高淀粉酶血症发生率较高（P=.001）。与腹腔镜胆囊切除术+胆总管切开取石+胆总管一期缝合+内镜鼻胆管引流相比，腹腔镜胆总管探查与胆漏较少相关（RR=0.03，95%CI：0.003-0.37）。
与腹腔镜胆囊切除术+胆总管切开取石+胆总管一期缝合+内镜鼻胆管引流相比，腹腔镜胆总管探查与胆漏相关。
