胆囊结石并胆总管结石微创治疗方式疗效对比研究

doi:10.3969/j.issn.1009-976X.2020.03.004

岭南现代临床外科 ›› 2020, Vol. 20 ›› Issue (03): 285-290.DOI: 10.3969/j.issn.1009-976X.2020.03.004

胆囊结石并胆总管结石微创治疗方式疗效对比研究

林齐睿^1,2, 张延强³, 宋小锐², 刘苏^1,2, 黄东², 周万邦², 尹耀新², 龙光辉², 欧希², 林泽伟², 刘吉奎^2,*, 刘晓平^1,2,*

1.北京大学医学部（北京大学/香港科技大学医学中心）,广东深圳518036;
2.北京大学深圳医院肝胆外科,广东深圳518036;
3.浙江省肿瘤医院胃外科,浙江杭州 310022

通讯作者: *刘晓平,Email：ninliu @163.com;刘吉奎,Email：liu8929@126.com
基金资助:
广东省科技发展专项（2017B090904010）; 深圳市医疗卫生三名工程项目（SZSM201612021）

Comparative study of the effects of minimally invasive treatment of gallbladder stones and common bile duct stones

LIN Qi-rui^1,2, ZHANG Yan-qiang³, SONG Xiao-rui, LIU Su^1,2, HUANG Dong², ZHOU Wan-bang², YIN Yao-xin², LONG Guang-hui², OU Xi², LIN Ze-wei², LIU Ji-kui², LIU Xiao-ping^1,2

1. Peking University Health Science Centre （Peking University/Shenzhen PKU-HKUST Medical Center）; Shenzhen, Guangdong 518036;
2. Department of Hepatobiliary surgery,Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036;
3. Department of Gastrosurgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China

Received:2020-03-10 Online:2020-06-20 Published:2020-06-20
Contact: LIU Xiao-ping, ninliu @163.com; LIU Ji-kui, liu8929@126.com

摘要/Abstract

摘要： 目的比较腹腔镜胆总管探查（LCBDE）+一期缝合（PS）+腹腔镜胆囊切除术（LC）、腹腔镜胆总管探查+T管引流术（TD）+腹腔镜胆囊切除术和经内镜逆行胰胆管造影（ERCP）+腹腔镜胆囊切除术三种微创手术方式治疗胆囊结石合并胆总管结石的临床疗效。方法收集2012年7月至2017年7月于北京大学深圳医院因胆总管结石行手术治疗的229例患者的临床资料,对比分析三种微创治疗方式的术前、术中、术后及住院时间及费用情况的差异评价三种手术方式之间差异。结果三组患者在年龄、性别、术前ALT、术前TBil、胆总管直径、胆总管结石个数和胆总管结石最大直径的差异不具有统计学意义（P>0.05）;三组间术后TBIL、术后镇痛、术后并发症发生率差异无统计学意义（P>0.05）;ERCP+LC组较LCBDE+PS组和LCBDE+TD组手术时间短、术中出血量少、术后腹腔引流时间及术后抗生素使用时间短,但中转率高、术后禁食时间长、ALT恢复慢;LCBDE+PS组较ERCP+LC组和LCBDE+TD组术后住院时间短;三组间的住院费用ERCP+LC组>LCBDE+TD组>LCBDE+PS组。结论 ERCP+LC组具有手术时间短、术中出血少、术后腹腔引流时间和使用抗生素时间短的优点,也存在手术中转率较高、术后禁食时间长的缺点。LCBDE+PS组较LCBDE+TD组术后恢复快,生活质量影响小,且并发症发生率未见明显增多。

关键词: 一期缝合术, 经内镜逆行胰胆管造影, 胆囊结石合并胆总管结石, 腹腔镜胆总管探查术, T管引流术, 腹腔镜胆囊切除术

Abstract: Objective To compare the clinical efficacy of three minimally invasive surgical approaches for gallstones and common bile duct,which are laparoscopic common bile duct exploration （LCBDE）+primary closure （PS）+laparoscopic cholecystectomy （LC）,laparoscopic common bile duct exploration+T-tube drainage （TD）+laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography （ERCP）+laparoscopic cholecystectomy. Methods Collect clinical data of 229 patients who underwent surgery for common bile duct stones at Peking University Shenzhen Hospital from July 2012 to July 2017, and compare and analyze the three minimally invasive treatments before surgery. Evaluation of the differences in postoperative and hospitalization time and cost between the three surgical methods. Results The three groups of patients were： age, gender, preoperative ALT, preoperative TBil, common bile duct diameter, number of common bile duct stones, and bile The difference in the maximum diameter of the common stones was not statistically significant （P>0.05）; there was no statistical difference in the incidence of postoperative TBil, postoperative analgesia, and postoperative complications among the three groups. Significance （P>0.05）; ERCP+LC group has shorter operation time than LCBDE+PS+LC group and LCBDE+TD+LC group. There is less bleeding during surgery. Postoperative abdominal drainage time and postoperative antibiotic use time are shorter, but the transition High rate, long postoperative fasting time, and slow recovery of ALT; LCBDE+PS+LC group has shorter postoperative hospital stay than ERCP+LC group and LCBDE+TD+LC group; hospitalization costs between the three groups ERCP+LC group> LCBDE+TD+LC group> LCBDE+PS+LC group. Conclusion The ERCP + LC group has the advantages of shorter operation time, less bleeding during the operation, shorter postoperative abdominal drainage time, and shorter antibiotic use time. Disadvantages of long postoperative fasting time： LCBDE+PS+LC group recovers faster than LCBDE+TD+LC group after surgery, with less impact on quality of life, and the incidence of complications does not increase significantly.

Key words: laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, primary suture, T-tube drainage, gallbladder stones combined with common bile duct stones, laparoscopic cholecystectomy

中图分类号:

R657.4+2

林齐睿, 张延强, 宋小锐, 刘苏, 黄东, 周万邦, 尹耀新, 龙光辉, 欧希, 林泽伟, 刘吉奎, 刘晓平. 胆囊结石并胆总管结石微创治疗方式疗效对比研究[J]. 岭南现代临床外科, 2020, 20(03): 285-290.

LIN Qi-rui, ZHANG Yan-qiang, SONG Xiao-rui, LIU Su, HUANG Dong, ZHOU Wan-bang, YIN Yao-xin, LONG Guang-hui, OU Xi, LIN Ze-wei, LIU Ji-kui, LIU Xiao-ping. Comparative study of the effects of minimally invasive treatment of gallbladder stones and common bile duct stones[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 285-290.

参考文献

[1] Williams E, Beckingham I, El SG, et al.Updated guideline onthe management of common bile duct stones (CBDS)[J]. Gut, 2017, 66(5):765-782.
[2] Vannijvel M, Lesurtel M, Bouckaert W, et al.A survey ofEuropean-African surgeons' management of common bile ductstones[J]. HPB (Oxford), 2016, 18(12):959-964.
[3] Wandling MW, Hungness ES, Pavey ES, et al.Nationwideassessment of trends in choledocholithiasis management in theUnited States from 1998 to 2013[J]. JAMA Surg, 2016, 151(12):1125-1130.
[4] 殷子, 徐康, 孙健, 等. 腹腔镜胆总管探查取石术后一期缝合与T管引流随机对照试验的系统评价和meta-分析[J]. 岭南现代临床外科, 2011, 11(6): 404-412.
[5] Rogers SJ, Cello JP, Horn JK, et al.Prospective randomizedtrial of LC+LCBDE vs ERCP/S+LC for common bile duct stonedisease[J]. Arch Surg, 2010, 145(1):28-33.
[6] Singh AN, Kilambi R.Single-stage laparoscopic common bileduct exploration and cholecystectomy versus two-stage endoscopicstone extraction followed by laparoscopic cholecystectomyfor patients with gallbladder stones with common bile ductstones: systematic review and meta-analysis of randomized trialswith trial sequential analysis[J]. Surg Endosc, 2018, 32(9):3763-3776.
[7] Feng Q, Huang Y, Wang K, et al.Laparoscopic transcysticcommon bile duct exploration: advantages over laparoscopiccholedochotomy[J]. PLoS One, 2016, 11(9):e0162885.
[8] El-Geidie AA.Is the use of t-tube necessary after laparoscopiccholedochotomy?[J]. J Gastrointest Surg, 2010, 14(5):844-848.
[9] Overby DW, Apelgren KN, Richardson W, Fanelli R.SAGES guidelines forthe clinical application of laparoscopic biliary tract surgery[J]. Surg Endosc, 2010, 24(10):2368-2386.
[10] Chathadi KV, Chandrasekhara V, Acosta RD, et al.The role of ERCP in benigndiseases of the biliary tract[J]. Gastrointest Endosc, 2015, 81(4):795-803.
[11] 钟鼎文, 邓小红, 谢元才, 等. 三镜联合治疗胆囊结石合并胆总管结石的体会[J].岭南现代临床外科 2012, 12(5): 293-294.
[12] Lu J, Cheng Y, Xiong XZ, et al.Two-stage vs single-stage management for concomitant gallstones and common bile duct stones[J]. World J Gastroenterol, 2012, 18(24): 3156-3166.
[13] Barreras González JE, Torres Peña R, Ruiz Torres J, et al.Endoscopic versus laparoscopic treatment for choledocholithiasis: a prospective randomized controlled trial[J]. Endosc Int Open, 2016, 4(11): E1188-E1193.
[14] Gao YC, Chen J, Qin Q, et al.Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones: A meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2017, 96(37): e7925.
[15] Gupta N.Role of laparoscopic common bile duct exploration in the management of choledocholithiasis[J]. World J Gastrointest Surg, 2016, 8(5): 376-381.
[16] Zhang K, Zhan F, Zhang Y, et al.Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation[J]. Indian J Surg, 2016, 78(5): 364-370.
[17] Al-Temimi MH, Kim EG, Chandrasekaran B, et al.Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database”[J]. Am J Surg, 2017, 214(6): 1080-1081.
[18] Liu D, Cao F, Liu J, et al.Risk factors for bile leakage after primary closure following laparoscopic common bile duct exploration: a retrospective cohort study[J]. BMC Surg, 2017, 17(1): 1.
[19] 邹良旺,徐李娟,蔡华杰,施红旗. 腹腔镜胆总管切开取石一期缝合的适应证及手术操作细节[J]. 肝胆胰外科杂志, 2013, 25(1): 54-56.

胆囊结石并胆总管结石微创治疗方式疗效对比研究

Comparative study of the effects of minimally invasive treatment of gallbladder stones and common bile duct stones

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 9

编辑推荐

Metrics

[1]	陈海军，孙梓程，刘岩，张逖. 自制改良标本袋在腹腔镜胆囊切除术中的临床应用[J]. 岭南现代临床外科, 2020, 20(01): 25-28.
[2]	彭永辉，李达强，谢志华，崔文博，龚独辉，莫宇轩，李炳根，聂向阳. 预测性评分系统在降低腹腔镜胆囊切除术中转开腹率中应用探讨[J]. 岭南现代临床外科, 2019, 19(04): 400-404.
[3]	张耿，苏树英*，费凛，王忠辉. 内镜下胆道支架置入术在高位胆管恶性梗阻中的临床总结[J]. 岭南现代临床外科, 2019, 19(03): 256-259.
[4]	邝乃乐伍隽华许洁娜左超海余杰雄. 彩超引导下经皮经肝胆囊穿刺置管引流治疗41例高危人群急性胆囊炎[J]. 岭南现代临床外科, 2017, 17(06): 674-677.
[5]	巨邦律陈永兵张维一聂洪峰杨荣华沈小青于聪慧. 腹腔镜胆囊切除并胆总管探查术胆囊管入路法347例临床总结[J]. 岭南现代临床外科, 2016, 16(03): 279-281.
[6]	谭建志曾连华陈喜建刘镇湘. 老年患者急性胆囊炎行腹腔镜胆囊切除术与开腹式胆囊切除术的疗效比较[J]. 岭南现代临床外科, 2014, 14(02): 189-192.
[7]	黄美泰陈焕伟. 经皮肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性化脓性胆囊炎[J]. 岭南现代临床外科, 2013, 13(03): 208-210.
[8]	王浩熊沛. 胆囊息肉诊治的新进展[J]. 岭南现代临床外科, 2013, 13(03): 256-259.
[9]	胡刚计勇湛汇. ERCP/EST术后进行腹腔镜胆囊切除手术的时机选择[J]. 岭南现代临床外科, 2013, 13(01): 32-34.