目的:探討膽總管結石致急性梗阻性黃疸手術治療的效果。方法:回顧分析72例手術治療膽總管結石致急性梗阻性黃疸患者的臨床資料。結果:術后死亡3例。隨訪3~6年,效果優良者62例。3例膽總管T管引流術后3年復發肝膽管結石。結論:對該病的治療術前應盡量做全面輔助檢查,明確結石的部位及大小,膽管的形態及位置。根據病情確定手術時機和方式,對保證患者安全,減少術后并發癥,提高治愈率有重要意義。
目的 比較腹腔鏡膽道探查術后膽總管一期縫合與T管引流兩種術式治療膽囊結石合并膽管結石的療效。方法 回顧性分析2011年4月至2012年5月期間筆者所在科室收治的因膽囊結石合并膽管結石接受腹腔鏡膽囊切除＋膽道探查治療的109例患者的臨床資料，其中58例行T管引流，51例行一期膽總管縫合。比較2組患者的手術時間、住院時間、治療費用、術后恢復正常生活時間以及手術并發癥情況。結果 T管引流組術后發生膽瘺2例（3.4%），一期縫合組術后發生膽瘺1例（2.0%），其差異無統計學意義（P＞0.05）。2組患者的手術時間、住院時間及住院治療費用的差異均無統計學意義（P＞0.05）。一期縫合組患者術后恢復正常生活時間為（7.2±1.1） d，短于T管引流組的（28.2±2.7）d（P=0.001）。結論 經腹腔鏡膽道探查術后一期膽總管縫合是安全可行的，可縮短患者的康復時間，提高患者圍手術期生活質量。
目的比較腹腔鏡下膽總管探查一期縫合與T管引流治療肝外膽管結石的效果，總結腹腔鏡下膽總管探查一期縫合的臨床經驗。 方法回顧性分析2010年1月至2012年12月期間于中國人民解放軍總醫院施行腹腔鏡下膽總管探查取石的121例肝外膽管結石患者的臨床資料，比較一期縫合組（n=63）與T管引流組（n=58）的手術時間、術中出血量、術后住院時間、膽瘺發生率、膽總管狹窄發生率及結石復發率。 結果2組患者均順利完成腹腔鏡手術。術后一期縫合組發生膽瘺3例，T管引流組發生1例。2組患者的術中出血量和膽瘺發生率比較差異均無統計學意義（P＞0.05），但T管引流組的手術時間和術后住院時間均較長（P=0.000）。術后所有患者獲訪4～36個月，平均12個月。隨訪期間均無復發、膽總管狹窄及死亡發生。 結論腹腔鏡下膽總管探查一期縫合治療肝外膽管結石安全而有效，并且避免了術后T管的護理，有望成為處理肝外膽管結石的主流術式。
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.
Objective To assess the benefits and harms of routine primary suture (LBEPS) versus T-tube drainage (LCHTD) following laparoscopic common bile duct stone exploration. Methods The randomized controlled trials (RCTs) or quasi-RCTs were electronically searched from the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2010), PubMed (1978 to 2010), EMbase (1966 to 2010), CBMdisc (1978 to 2010), and CNKI (1979 to 2010); and the relevant published and unpublished data and their references were also searched by hand. The data were extracted and the quality was evaluated by two reviewers independently, and the RevMan 5.0 software was used for data analysis. Results Four studies including 3 RCTs and 1 quasi-RCT involving 274 patients were included. The meta-analysis showed that compared with LCHTD, LBEPS was better in shortening operation time (WMD= –17.11, 95%CI –25.86 to –8.36), abdominal drainage time (WMD= –0.74, 95%CI –1.39 to –0.10) and post-operative hospitalization time (WMD= –3.30, 95%CI –3.67 to –2.92), in lowering hospital expenses (WMD= –2 998.75, 95%CI –4 396.24 to –1 601.26) and in reducing the complications due to T-tube such as tube detaching, bile leakage after tube drawing, and choleperitonitis (RR=0.56, 95%CI 0.29 to 1.09). Conclusion LBEPS is superior to LCHTD in total effectiveness for common bile duct stone with the precondition of strictly abiding by operation indication. Due to the low quality of the included studies which decreases the reliability of this conclusion, more reasonably-designed and strictly-performed multi-centered RCTs with large scale and longer follow up time are required to further assess and verify the efficacy and safety of this treatment.