腹腔镜胆总管探查一期缝合的适应症、手术方法和并发症的研究现状

doi:10.3969/j.issn.1009-976X.2020.06.020

摘要/Abstract

摘要： 随着腹腔镜、胆道镜等技术的发展及快速康复外科理念的更新,荒置了一个世纪的胆总管探查一期缝合术再次成为研究热点。一期缝合可分为三种方式：单纯一期缝合、一期缝合联合内引流、一期缝合联合外引流。虽然目前已有多项Meta分析证实了一期缝合的有效性及安全性,但也有不少学者担心一期缝合可能会增加术后胆漏、胆道残石、胆道狭窄等风险。胆总管切开探查后是留置T管还是一期缝合,目前国内外仍没有共识。

关键词: 一期缝合, 胆石病

Abstract: With the development of laparoscopy and choledochoscopy and the renewal of the concept of enhanced recovery after surgery, the primary closure of common bile duct exploration, which has been idled for a century, has once again become a research hotspot. Primary closure can be divided into three methods： simple primary closure,primary closure combined with internal biliary drainage, and primary closure combined with external biliary drainage. Although there have been a number of Meta-analysis confirming the effectiveness and safety of primary closure, many scholars worry that primary closure may increase the risks of postoperative bile leakage, biliary residual stones, and biliary stricture. There is still no consensus for T-tube drainage or primary closure after laparoscopic common bile duct exploration at present.

Key words: primary closure, gallstone disease

中图分类号:

R657.4+2

李文韬, 李汉卿, 黄沾任, 陈念平. 腹腔镜胆总管探查一期缝合的适应症、手术方法和并发症的研究现状[J]. 岭南现代临床外科, 2020, 20(06): 784-788.

LI Wen-tao, LI Han-qing, HUANG Zhan-ren, CHEN Nian-ping. Research status of indications, surgical methods and complications of primary closure after laparoscopic common bile duct exploration[J]. Lingnan Modern Clinics in Surgery, 2020, 20(06): 784-788.

参考文献

[1] Halstead WS. Surgical Papers.Vol 2 [M]. Baltimore, MD: The Johns HopkinsUniversity Press, 1924: 427-472.
[2] 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.
[3] Hua J, Lin S, Qian D, et al.Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy[J]. Dig Surg, 2015, 32(1): 1-8.
[4] 索运生, 徐琳, 陈安平, 等. 腹腔镜胆总管探查一期缝合669例报告[J]. 中国微创外科杂志, 2008, 14(10): 942-944.
[5] 郑亚民, 刘东斌, 王悦华, 等. 胆囊结石继发胆总管结石腹腔镜外科手术治疗方法的选择策略[J]. 中华外科杂志, 2019, 57(4): 282-287.
[6] 刘波, 王洪林, 罗强, 张毅. 单向免打结倒刺线在腹腔镜胆道探查一期缝合术中的临床应用[J]. 腹腔镜外科杂志, 2019, 24(7): 511-514.
[7] 王程, 黄强, 杨骥. 腹腔镜胆总管一期缝合术中单向倒刺线与传统缝线比较的系统评价[J]. 腹部外科, 2019, 32(5): 340-345.
[8] Yokoyama K, Tanigawa N, Ogata A, et al.Laparoscopic technique and initial experiences of choledocholithotomy closure with knotless unidirectional barbed sutures after surgery for biliary stone disease[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): e129-e133.
[9] Fernandez LC, Toriz A, Hernandez J, et al.Knotless choledochorraphy with barbed suture, safe and feasible[J]. Surg Endosc, 2016, 30(8): 3630-3635.
[10] 张爱民, 熊良昆, 余佳. 腹腔镜手术一期缝合胆总管治疗胆总管结石的研究进展[J]. 临床外科杂志, 2015, 23(12): 949-951.
[11] 毛海香, 朱杰, 张斌, 王海彪. 腹腔镜胆总管一期分层缝合减少术后胆漏的临床观察[J].肝胆胰外科杂志, 2019, 31(2): 80-82, 97.
[12] Raza A, Omer A, Iqbal S, et al.Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review[J]. Clin Endosc, 2019, 52(2):159-167.
[13] Costamagna G, Shah SK, Tringali A.Current management of postoperative complications and benign biliary strictures[J]. Gastroint Endosc Clin N Am, 2003, 13(4): 635-648.
[14] 吕忠. 三镜联合胆总管一期缝合治疗胆囊、胆总管结石[J]. 肝胆胰外科杂志, 2006, 18(4): 242-243.
[15] 张立洪, 陶立德, 曾佳, 等. 保护Oddi括约肌功能的三镜联合治疗胆总管结石合并胆囊结石[J]. 中华普通外科杂志, 2019, 34(11): 994-995.
[16] Kawakubo K, Kawakami H, Kuwatani M, et al.Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma[J]. World J Gastrointest Endosc, 2016, 8(9): 385-390.
[17] 蔡军, 龚仁华, 孙登群, 等. 三镜联合胆总管探查一期缝合临床分析[J]. 中国内镜杂志, 2015, 21(3): 308-310.
[18] 俞亚红, 温松奇, 杨光耀, 等. 术中鼻胆管置入在三镜联合胆总管探查一期缝合的临床应用[J]. 中华肝胆外科杂志, 2013, 19(2): 152-154.
[19] 王雷, 张向化, 伍路, 等. PTCD与ENBD对恶性梗阻性黄疸术前减黄效果的临床比较[J]. 肝胆胰外科杂志, 2019, 31(5): 310-313.
[20] 梁玉河, 徐均伟, 杨晓军. 腹腔镜胆总管探查术后一期缝合留置经皮肝穿刺胆道引流管的临床研究[J]. 腹腔镜外科杂志, 2017, 22(9): 673-676.
[21] Huang SM, Yao CC, Cheng YW, et al.Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis[J]. Am Surg, 2010, 76(5): 517-521.
[22] 陈章彬, 陈见中, 滕毅山. 经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后一期缝合中的应用价值[J]. 中国普通外科杂志, 2018, 27(2): 156-162.
[23] Saxena P, Kumbhari V, Zein ME, el al. Preoperative biliary drainage[J]. Dig Endosc, 2015, 27(2): 265-277.
[24] 薛鸿, 岳鹏, 刘晶晶, 等. 经ERCP途径与PTCD途径治疗恶性梗阻性黄疸疗效比较的系统评价[J]. 中国内镜杂志, 2019, 25(3): 17-26.
[25] Bin OY, Zeng KW, Hua HW.Endoscopic nasobiliary drainage and percutaneous transhepatie biliary drainage for the treatment of acute obstructive suppurative cholangitis: a retrospective study of 37 cases[J]. Hepatogastroenterology, 2012, 59(120): 2454-2456.
[26] Darkahi B, Liljeholm H, Sandblom G.Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center[J]. Front Surg, 2016, 3: 23.
[27] 田明国, 温新元, 杨勇, 等. 眼镜蛇形自行脱落胆道支架在改良四孔法腹腔镜胆总管探查术中的应用体会[J]. 腹腔镜外科杂志, 2019, 24(2): 112-115.
[28] 潘德盛, 余杰雄, 左超海. 腹腔镜胆总管探查一期缝合胆道内支架管的应用经验[J]. 岭南现代临床外科, 2018, 18(6): 636-639.
[29] 田明国, 王立云, 杨俊峰, 等. 腹腔镜胆总管探查定期自行脱落J型胆道支架引流术150例报告[J]. 肝胆胰外科杂志, 2013, 25(2): 96-99.
[30] Zheng YM, Liu DB, Wang YH, et al.Operative method choice and strategy of laparoscopic surgery therapy for gallbladder stones and common bile duct stones[J]. Chin J Surg, 2019, 57(4): 282-287.
[31] 陈舍黄, 王学海, 黄高石, 等. 胆道内支架管引流在腹腔镜胆总管探查一期缝合术中的临床应用[J]. 腹腔镜外科杂志, 2018, 23(8): 602-605.
[32] 彭则男, 廖启成, 谢星, 王小农. 腹腔镜下胆总管探查取石术后一期缝合的研究进展[J].赣南医学院学报, 2020, 40(2): 188-192, 211.
[33] Lyu Y, Cheng Y, Li T, et al.Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis[J]. Surg Endosc, 2019, 33(10):3275-3286.
[34] Lyon M, Menon S, Jain A, Kumar H.Use of biliary stent in laparoscopic common bile duct exploration[J]. Surg Endosc, 2015, 29(5): 1094-1098.
[35] 温军业, 张海强, 脱红芳, 等. 腹腔镜胆总管切开取石一期缝合的研究进展[J]. 中国普通外科杂志, 2016, 25(8): 1213-1218.
[36] 王凡, 邓流恒, 郑小林, 蔡常春. 腹腔镜胆总管切开取石一期缝合胆管术后并发症处理的单中心经验[J]. 腹部外科, 2018, 31(3): 194-198.
[37] 刘东斌, 刘家峰, 徐大华, 等. 腹腔镜胆总管探查一期缝合术并发症及治疗策略[J]. 腹腔镜外科杂志, 2015, 20(1): 46-48.
[38] 饶尚锐, 潘忠良, 石铮. 腹腔镜胆总管一期缝合术后胆漏的多因素分析——血浆白蛋白水平是胆漏发生的独立危险因素[J]. 中国微创外科杂志, 2013, 13(11): 982-984.
[39] 饶尚锐. 腹腔镜胆总管切开取石一期缝合术后胆漏的临床分析[D]. 福建医科大学, 2010: 1-28.
[40] 于安星, 吴承先, 刘哲. 腹腔镜胆总管切开一期缝合术后胆漏的原因及处理方法[J]. 中华肝胆外科杂志, 2016, 22(7): 490-492.
[41] 倪平志, 刘隽, 汤可立, 等. 胆总管探查术后一期缝合的临床经验及适应证探讨[J]. 中国普外基础与临床杂志, 2011, 18(3): 320-323.
[42] 管辉球, 景岚, 徐锁青. 胆总管一期缝合经胆囊管胆管引流与鼻胆管引流的对比研究[J]. 中华外科杂志, 2018, 56(2): 130-134.
[43] 谷鹏程, 颜廷启, 王清馨. 生长抑素在肝胆手术后胆漏治疗中的临床应用[J]. 临床合理用药杂志, 2012, 5: 15-16.
[44] 潘峥, 程张军, 刘胜利, 等. 胆总管结石腹腔镜胆总管探查术后一期缝合与T管引流的临床比较[J]. 中国普通外科杂志, 2015, 24(8): 1135-1139.
[45] Yi HJ, Hong G, Min SK, et al.Long-term Outcome of Primary Closure After Laparoscopic Common Bile Duct Exploration Combined With Choledochoscopy[J]. Surg Laparosc Endosc Percutan Tech, 2015, 25(3): 250-253.
[46] 严培虎, 马延龄, 白玉玲, 等. 术中置入胆道减压管在腹腔镜胆总管切开探查术后一期缝合的临床研究[J]. 中华普通外科杂志, 2018, 33(10): 861-864.
[47] Jiang C, Zhao X, Cheng S. T-Tube Use After Laparoscopic Common Bile Duct Exploration [J]. JSLS, 2019, 23(1): e2018.00077.
[48] 中国研究型医院学会肝胆胰外科专业委员会, 国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病微创手术治疗指南(2019版)[J]. 中华消化外科杂志, 2019, 18(5): 407-413.
[49] 肝胆管结石病胆肠吻合术应用专家共识(2019版)[J].中华消化外科杂志,2019(05):414-418.
[50] Podda M, Polignano FM, Luhmann A, et al.Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholihiasis[J]. Surg Endosc, 2016, 30(3): 845-861.
[51] 吴涛, 熊廷刚, 高绪照, 等. 腹腔镜胆总管切开取石胆总管一期缝合的疗效与安全性分析[J]. 肝胆胰外科杂志, 2019, 31(8): 486-488.
[52] Decker G, Borie F, Millat B, et al.One hundred laparoscopic choledochotomies with primary closure of the common bile duct[J]. Surg Endosc, 2003, 17(1): 12-18.
[53] Yin Z, Xu K, Sun J, et al.Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis[J]. Ann Surgery, 2013, 257(1): 54-66.