摘要
目的:探讨腹腔镜胆道探查一期缝合术中通过经皮经肝穿刺胆道引流管行胆道造影检查及注水试验的应用价值。方法:依据严格的纳入标准,选取2015年6月至2018年6月收治的126例胆囊结石并胆总管结石患者,采用随机数表法将患者分为观察组(n=64)与对照组(n=62),观察组术中胆总管一期缝合后通过经皮经肝穿刺胆道引流管行胆道造影及注水试验;对照组仅行胆总管一期缝合。对比分析两组术前一般资料、手术相关情况、并发症、术后住院时间、住院费用。结果:两组术前一般资料、手术时间、术中出血量、术后通气时间、术后胆道感染发生率差异无统计学意义(P>0.05);观察组胆漏发生率(0vs.11.3%)及结石残留率(0vs.8.1%)低于对照组(P<0.05),术后住院时间、住院费用少于对照组(P<0.05)。结论:腹腔镜胆道探查一期缝合术中通过经皮经肝穿刺胆道引流管行胆道造影检查及注水试验可减少术后结石残留,降低术后二次手术风险,同时减少术后胆漏的发生,患者康复快,花费少,且操作简单、易行,符合微创及快速康复外科理念,值得临床推广。
Objective:To evaluate the application value of the percutaneous transhepatic cholangiography and the water injection test in laparoscopic common bile duct exploration with primary suture.Methods:According to strict inclusion criteria,126 patients who suffered from cholecystolithiasis and choledocholithiasis were selected from Jun.2015 to Jun.2018,all patients were divided into observation group ( n = 64) and control group ( n = 62) by random number table method,patients in observation group underwent percutaneous transhepatic cholangiography and the water injection test after primary suture of common bile duct,while patients in control group only underwent primary suture of common bile duct.The general information before the operation,operation related conditions,complications, postoperative hospital stay and hospitalization expenses of the two groups were analyzed and compared.Results:There was no significant difference in preoperative general information,operation time,intraoperative blood loss,postoperative ventilation time or the incidence of biliary duct infection between the two groups ( P>0.05).The incidence of biliary leakage ( 0 vs.11.3%) and residual stone rate ( 0 vs.8.1%),the hospital stay and hospitalization expenses in the observation group were less than those in the control group ( P <0.05).Conclusions:The intraoperative percutaneous transhepatic cholangiography and the water injection test in laparoscopic common bile duct exploration with primary suture can reduce the residual stones,the risk of second operation after operation,and the incidence of bile leakage after operation.This procedure is associated with quick recovery,few cost,simple and easy operation,it conforms to the concept of minimal invasion and enhanced recovery after surgery,and is worthy of clinical promotion.
作者
王斌
陈章彬
白锦峰
陈见中
滕毅山
WANG bin;CHEN Zhang-bin;BAI Jin-feng(The Third Ward of Hepatobiliary Pancreatic Surgery,the Second Affiliated Hospitalof Kunming Medical University,Kunming 650101,China)
出处
《腹腔镜外科杂志》
2019年第6期427-432,459,共7页
Journal of Laparoscopic Surgery
关键词
胆囊结石病
胆总管结石
腹腔镜检查
胆道造影
注水试验
Cholecystolithiasis
Choledocholithiasis
Laparoscopy
Cholangiography
Water injection test
