腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用

doi:10.3969/j.issn.1006-7795.2017.01.016

首都医科大学学报 ›› 2017, Vol. 38 ›› Issue (1): 78-81.doi: 10.3969/j.issn.1006-7795.2017.01.016

腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用

梁阔, 刘东斌, 刘家峰, 徐大华, 王悦华, 李非

首都医科大学宣武医院普通外科首都医科大学普通外科学系, 北京 100053

收稿日期:2016-10-25 出版日期:2017-01-21 发布日期:2017-01-20
通讯作者: 李非 E-mail:feili36@ccmu.edu.cn
基金资助:
北京市卫生系统高层次卫生技术人才基金（2014-3-058）。

Application of laparoscopic common bile duct exploration with primary closure in treatment of choledocholithiasis in elderly patients

Liang Kuo, Liu Dongbin, Liu Jiafeng, Xu Dahua, Wang Yuehua, Li Fei

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Received:2016-10-25 Online:2017-01-21 Published:2017-01-20
Supported by:
This study was supported by Beijing Health System High Level Health Technical Personnel(2014-3-058).

摘要/Abstract

摘要： 目的探讨腹腔镜胆总管探查一期缝合在老年胆囊结石合并胆总管结石病人治疗中的安全性和可行性。方法回顾性分析63例胆囊结石合并胆总管结石老年病人（≥65岁）行腹腔镜联合胆道镜胆总管探查一期缝合术的手术资料与随访资料。结果本组63例腹腔镜联合胆道镜行胆总管探查取石手术均顺利完成，无1例中转开腹，手术时间43~164 min，平均（79.8±20.5）min；出血量10~150 mL，平均（24.4±21.1）mL；术后住院时间3~15 d，平均（6.6±1.9）d；发生胆漏6例，再次手术1例。术后随访3~48个月，残余胆总管结石1例。结论腹腔镜联合胆道镜胆总管探查一期缝合术具有创伤小、恢复快的优势，在严格把握手术指征、熟练掌握胆道镜操作、镜下精细缝合前提下，应用于老年胆囊结石合并胆总管结石病人是安全可行的。

关键词: 腹腔镜, 胆总管探查, 胆总管结石, 一期缝合, 老年

Abstract: Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) with primary closure for management of choledocholithiasis in elderly patients. Methods The clinical data of 63 elderly patients (≥65 years) with gallbladder stones complicated with choledocholithiasis who were undergone LCBDE and primary closure from July 2012 to July 2016 were retrospectively analyzed.Results LCBDE and primary closure of all the 63 cases were successfully completed. The operative time was 43-164 (79.8±20.5) min, the blood loss was 10-150 (24.4±21.1) mL, postoperative hospital stay was 3-15 (6.6±1.9) d.Six cases suffered from bile leakage and one of them received second operation. During the follow-up of 3 to 48 months, residual common bile duct stones presented in 1 case.Conclusion LCBDE with primary closure has the advantages of minimal invasion and rapid recovery. It is safe and feasible to treat the elderly patients with common bile duct stones under the premise of strict surgical indications, skilled laparoscopic procedures and accurate endoscopic suture techniques.

Key words: laparoscopy, common bile duct exploration, choledocholithiasis, primary closure, elderly patients

中图分类号:

R657.4

梁阔, 刘东斌, 刘家峰, 徐大华, 王悦华, 李非. 腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用[J]. 首都医科大学学报, 2017, 38(1): 78-81.

Liang Kuo, Liu Dongbin, Liu Jiafeng, Xu Dahua, Wang Yuehua, Li Fei. Application of laparoscopic common bile duct exploration with primary closure in treatment of choledocholithiasis in elderly patients[J]. Journal of Capital Medical University, 2017, 38(1): 78-81.

参考文献

[1] Stoker M E, Leveillee R J, McCann J C Jr, et al. Laparoscopic common bile duct exploration[J]. J Laparoendosc Surg, 1991,1(5):287-293.
[2] Chan D S, Jain P A, Khalifa A, et al. Laparoscopic common bile duct exploration[J]. Br J Surg, 2014, 101(11):1448-1452.
[3] Aawsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration:15-year experience in a district general hospital[J]. Surg Endosc, 2016, 30(6):2563-2566.
[4] 郑楚发, 王小忠, 黄耀奎, 等. 腹腔镜胆总管探查术治疗胆总管结石[J].中华肝胆外科杂志, 2016, 22(6):378-381.
[5] 李建伟, 刘秋华, 张伯, 等. 腹腔镜胆总管探查术与传统开腹手术治疗胆总管结石的临床效果比较[J]. 肝胆胰外科杂志, 2014,26(5):411-413.
[6] Zhang H W, Chen Y J, Wu C H, et al. Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis:a retrospective analysis and comparison with conventional T-tube drainage[J]. Am Surg, 2014, 80(2):178-181.
[7] 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 Surg, 2013, 57(1):54-66.
[8] 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(11):855-858.
[9] 王帅, 黄汉飞, 段键, 等. 胆总管一期缝合术与T型管引流术治疗胆总管结石的对比研究[J] 中华普通外科杂志, 2013, 28(5):351-353.
[10] 徐红星, 徐海滨, 顾玉青, 等. 腹腔镜胆总管探查术后一期缝合与T管引流的临床研究[J]. 中国普外基础与临床杂志, 2015, 22(10):1254-1256.
[11] 刘东斌,刘家峰,徐大华, 等. 腹腔镜胆总管切开取石一期缝合术治疗胆总管结石53例分析[J]. 腹腔镜外科杂志, 2013,18(7):524-526.
[12] 刘东斌,刘家峰,徐大华, 等. 老年胆石症病人腹腔镜胆总管切开取石一期缝合35例分析[J]. 实用老年医学, 2013,27(10):847-849.
[13] 宋勇, 黄亚川, 秦高平. 个体化治疗老年急性梗阻性化脓性胆管炎病人的临床研究[J].首都医科大学学报, 2015, 36(03):449-453.
[14] 尹碧辉. 腹腔镜与开腹胆总管探查术治疗胆总管结石的临床效果比较[J]. 世界华人消化杂志, 2015,23(22):3620-3623.
[15] Sugawa C, Brown K L, Matsubara T, et al. The role of endoscopic biliary sphincterotomy for the treatment of type 1 biliary dysfunction (papillary stenosis) with or without biliary stones[J]. Am J Surg, 2014, 207(1):65-69.
[16] Oliveira-Cunha M, Dennison A R, Garcea G. Late Complications After Endoscopic Sphincterotomy[J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(1):1-5.
[17] Cai H, Sun D, Sun Y, et al. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy[J]. World J Surg, 2012, 36(1):164-170.
[18] Shively E H, Richardson M, Romines R, et al. Laparoscopic common bile duct exploration in 90-bed rural hospital[J]. Am Surg, 2010, 76(6):626-629.
[19] 刘立川, 张峻, 刘伟. 腹腔镜胆总管探查术治疗老年胆总管结石[J]. 中国普通外科杂志, 2014, 23(8):1154-1156.
[20] 邱枫,王今. 腹腔镜与开腹直肠癌手术近期疗效对比[J]. 首都医科大学学报, 2013, 34(5):689-692.
[21] 王海彪,胡元达,黄胜. 分层缝合在腹腔镜胆总管切开取石一期缝合术中的应用[J].中国微创外科杂志, 2014,14(10):910-912.

腹腔镜胆总管探查一期缝合在老年胆总管结石病人中的应用

Application of laparoscopic common bile duct exploration with primary closure in treatment of choledocholithiasis in elderly patients

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