切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 208 -212. doi: 10.3877/cma.j.issn.1674-0793.2019.03.009

所属专题: 文献

论著

腹腔镜胆总管结石探查后胆总管不同闭合方式的对比研究
张海雄1, 陈焕伟2,()   
  1. 1. 528000 佛山市禅城中心医院消化一区
    2. 528000 佛山市第一人民医院肝胆外科
  • 收稿日期:2018-10-30 出版日期:2019-06-01
  • 通信作者: 陈焕伟

Comparative study of different bile duct closure methods for laparoscopic common bile duct discovery for choledocholithiasis

Haixiong Zhang1, Huanwei Chen2,()   

  1. 1. Department of Digestion Medicine, Chancheng Central Hospital of Foshan, Foshan 528000, China
    2. Department of Hepatobiliary Surgery, theFirst People’s Hospital of Foshan, Foshan 528000, China
  • Received:2018-10-30 Published:2019-06-01
  • Corresponding author: Huanwei Chen
  • About author:
    Corresponding author: Chen Huanwei, Email:
引用本文:

张海雄, 陈焕伟. 腹腔镜胆总管结石探查后胆总管不同闭合方式的对比研究[J/OL]. 中华普通外科学文献(电子版), 2019, 13(03): 208-212.

Haixiong Zhang, Huanwei Chen. Comparative study of different bile duct closure methods for laparoscopic common bile duct discovery for choledocholithiasis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(03): 208-212.

目的

探讨腹腔镜胆总管结石探查后不同胆总管闭合方式的治疗效果。

方法

回顾性分析2012年6月至2017年5月佛山市第一人民医院和佛山市禅城中心医院298例行腹腔镜胆囊切除和同期胆总管取石患者的临床资料。比较腹腔镜胆囊切除术和胆总管探查术后胆总管不同闭合方式患者的严重并发症发生率(Clavien-Dindo分级≥Ⅲ级)、术后胆漏发生率(Grade分级A/B/C)、住院时间、再入院率、胆总管结石复发和其他相关并发症。

结果

74例(24.8%)行胆总管一期缝合术,118例(39.6%)行T管引流术,106例(35.6%)行胆总管支架引流术。一期缝合、T管引流术以及内支架引流的患者住院时间分别为2~30(5.8±3.7) d、7~75(11.6±8.9) d和7~56(9.8±5.1) d,差异有统计学意义(F=5.96,P=0.04);再入院率分别为0(0/74)、10.2%(12/118)、5.7%(6/106),差异有统计学意义(χ2=8.25,P=0.02);术后总并发症发生率分别为28.4%(21/74)、31.4%(37/118)、27.4%(29/106),严重并发症的发生率分别为0(0/74)、7.6%(9/118)、4.7%(5/106),差异有统计学意义(χ2=6.52,P=0.04);术后胆漏并发症分别为23.0%(17/74)、16.9%(20/118)和8.5%(9/106),差异有统计学意义(χ2=7.34,P=0.02)。但胆总管一期缝合术无C级胆漏发生,B级胆漏通过延长引流而治愈;术后结石复发率分别为2.7%(2/74)、4.2%(5/118)、11.3%(12/106),差异有统计学意义(χ2=6.91,P=0.03)。

结论

腹腔镜胆总管结石探查术后采用T管引流和内支架植入并不能带来更多的益处,反而有较多相关的并发症。尽管胆总管一期缝合容易出现术后胆漏,但很少出现严重的并发症。

Objective

To analyze the therapeutic effect of different bile duct closure methods for laparoscopic common bile duct exploration for choledocholithiasis.

Methods

The clinical data of two hundred and ninety-eight patients who underwent laparoscopic cholecystectomy and choledocholithotomy from June 2012 to May 2017 in Chancheng Central Hospital of Foshan and the First Peoples Hospital of Foshan were retrospectively analyzed. The incidence of severe complications (Clavien-Dindo> III), the incidence of bile leakage (Grade A/B/C), hospitalization time, re-admission rate, recurrence of common bile duct stones and other related complications were compared among patients with different closure modes of common bile duct.

Results

There were 74 cases (24.8%) undergoing primary suture of common bile duct, 118 cases (39.6%) undergoing T-tube drainage and 106 cases (35.6%) undergoing stent drainage. The hospitalization time of patients with primary suture, T-tube drainage and stent drainage was 2-30 (5.8±3.7) days, 7-75 (11.6±8.9) days and 7-56 (9.8±5.1) days, respectively, the difference was statistically significant (F=5.96, P=0.04); the re-admission rates were 0 (0/74), 10.2% (12/118) and 5.7% (6/106), respectively (χ2=8.25, P=0.02); the total incidence of postoperative complications was 28.4% (21/74), 31.4% (37/118) and 27.4% (29/106) and the incidence of severe complications was 0 (0/74), 7.6% (9/118) and 4.7% (5/106), respectively, the difference was statistically significant (χ2=6.52, P=0.04); postoperative complications of biliary leakage was 23.0% (17/74), 16.9% (20/118) and 8.5% (9/106), respectively (χ2=7.34, P=0.02). However, Grade C bile leakage did not occur in primary suture of common bile duct and Grade B bile leakage was cured by prolonging drainage. Postoperative stone recurrence rates of patients with primary suture, T-tube drainage and stent drainage were 2.7% (2/74), 4.2% (5/118) and 11.3% (12/106), with statistically significant difference (χ2=6.91, P=0.03).

Conclusions

T-tube drainage and stent implantation after laparoscopic choledocholithotomy do not bring more benefits, on the contrary, there are many related complications. Although primary suture of common bile duct is prone to bile leakage after operation, there are few serious complications.

表1 胆总管不同闭合方式患者的一般情况比较
表2 胆总管不同闭合方式患者术后胆道相关并发症情况比较[例(%)]
表3 胆总管不同闭合方式患者术后胆漏并发症严重程度以及Clavien-Dindo分级
[1]
李志钰, 冯亮, 尹飞飞, 等. 胆囊结石合并胆总管结石诊治进展[J]. 中国综合临床, 2014, 30(11): 1227-1229.
[2]
Samardzie J, Latic F, Kraljik D, et al. Treatment of common bile duct stones-is the role of ERCP chaged in era of minimally invasive surgery?[J]. Med Arh, 2010, 64(3): 187-188.
[3]
Dasari BV, Tan CJ, Gurusamy KS, et al. Surgical versus endoscopic treatment of bile duct stones[J]. Cochrane Database Syst Rev, 2013, 3(9): CD003327.
[4]
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213.
[5]
Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery[J]. Surgery, 2011, 149(5): 680-688.

URL    
[6]
Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: A randomized controlled trial[J]. Surg Endosc, 2014, 28(3): 875-885.

URL    
[7]
Ding G, Cai W, Qin M. Single-stage vs two-stage management for concomitant gallstones and common bile duct stones: A prospective randomized trial with long-term follow-up[J]. J Gastroinest Surg, 2014, 18(5): 947-951.
[8]
Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: An up-to-date Meta-analysis[J]. Ann Surg, 2018, 268(2): 247-253.
[9]
Baucom RB, Feurer ID, Shelton JS, et al. Surgeons, ERCP, and laparoscopic common bile duct exploration: Do we need a standard approach for common bile duct stones?[J]. Surg Endosc, 2016, 30(2): 414-423.
[10]
Zhang W, Li G, Chen YL. Should T-tube drainage be performed for choledocholithiasis after laparoscopic common bile duct exploration? A systematic review and Meta-analysis of randomized controlled trials[J]. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 415-423.
[11]
邵文浩, 徐钧. 腹腔镜胆总管探查术与内置管引流术的临床应用进展[J]. 中国临床实用医学, 2017, 8(4): 100-102.
[12]
Lyon M, Menon S, Jain A, et al. Use of biliary stent in laparoscopic common bile duct exploration[J]. Surg Endosc, 2015, 15, 29(5): 1094-1098.
[13]
吴鹏, 方路, 付小伟, 等. 单向倒刺线与普通可吸收线在腹腔镜胆总管切开取石一期缝合术中应用的对比研究[J]. 中国内镜杂志, 2016, 22(9): 52-56.

URL    
[14]
He MY, Zhou XD, Chen H, et al. Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: A systematic review and meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(3): 183-191.
[1] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[2] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[3] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[4] 康婵娟, 张海涛, 翟静洁. 胰管支架置入术治疗急性胆源性胰腺炎的效果及对患者肝功能、炎症因子水平的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 667-670.
[5] 姜宁宁, 蔺艳丽, 陈惠明. 胆总管结石患者腹腔镜胆总管探查术中应用“三针法”缝合方案的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 531-534.
[6] 陈燕. LCBDE和ERCP+EST治疗胆囊结石合并胆总管结石的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 385-388.
[7] 李佳伟, 庞建智, 闫鹏宇, 卫阳兵, 杨晓峰. 术中输尿管识别技术研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 520-524.
[8] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[9] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[10] 石阳, 于剑锋, 曹可, 翟志伟, 叶春祥, 王振军, 韩加刚. 可扩张金属支架置入联合新辅助化疗治疗完全梗阻性左半结肠癌围手术期并发症分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 464-471.
[11] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[12] 张迪, 王春霞, 张学东, 李发馨, 庞淅文, 陈一锋, 张维胜, 王涛. 梗阻性左半结直肠癌自膨式金属支架置入后行腹腔镜手术与开腹手术的短期临床疗效比较[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 375-380.
[13] 孙明策, 韩世焕. 海藻酸盐水凝胶支架在颅骨缺损修复中的应用进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 310-314.
[14] 李新宇, 梁建锋. 3D打印导板辅助颅内血肿穿刺引流手术[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(06): 382-384.
[15] 牟磊, 徐东成, 韩鑫, 徐长江, 韩坤锜, 薛叶潇, 牟媛, 秦文玲, 刘相静, 陈哲, 高楠. 五虫通络胶囊防治椎动脉开口支架术后再狭窄发生的效果[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 467-472.
阅读次数
全文


摘要