LCBDE术一期缝合治疗胆总管结石患者效果研究*

doi:10.3969/j.issn.1672-5069.2023.01.033

摘要/Abstract

摘要： 目的探讨采用腹腔镜胆总管探查术(LCBDE)一期缝合治疗胆总管结石患者的临床疗效。方法 2018年1月～2021年10月我院收治的74例胆总管结石患者,其中31例对照组患者接受LCBDE术联合T管引流治疗,另43例观察组患者接受LCBDE术胆总管一期缝合治疗。术后随访所有患者6个月。使用全自动生化分析仪检测血生化指标,采用放射免疫法检测应激反应指标肾上腺素(A)、促肾上腺皮质激素(ACTH)和皮质醇(COR)。结果观察组手术时间、腹腔引流时间和住院日分别为(91.3±12.6)min、(3.3±1.2)d和(5.9±1.2)d,显著短于对照组【分别为(115.4±19.2)min、(4.5±1.4)d和(8.6±1.5)d, P＜0.05】;手术前后,两组血清肝功能指标变化均无显著性差异(P＞0.05);在术后3 d,观察组血清A、ACTH和COR水平分别为(1.2±0.3)nmol/L、(13.6±4.1)ng/mL和(212.9±21.4)ng/mL,显著低于对照组【分别为(1.6±0.4)nmol/L、(17.2±4.8)ng/mL和(256.4±35.7)ng/mL,P＜0.05】;在术后6个月内,观察组并发症发生率为9.3%,显著低于对照组的29.0%(P＜0.05),观察组结石复发率为2.3%,与对照组的6.5%比,差异无统计学意义(P＞0.05)。结论采取LCBDE术一期缝合治疗胆总管结石患者可能更有利于改善围术期指标,减轻术后应激反应,降低并发症的发生风险,值得进一步研究。

关键词: 胆总管结石, 腹腔镜胆总管探查术, 一期缝合, T管引流, 应激反应, 治疗

Abstract: Objective The aim of this study was to investigate the clinical efficacy of primary suture laparoscopic common bile duct exploration (LCBDE) in the treatment of patients with choledocholithiasis. Methods 74 patients with choledocholithiasis were encountered in our hospital between January 2018 and October 2021, and among them, 31 patients in control group were treated with T-tube drainage after LCBDE and another 43 patients in observation group were treated with primary suture LCBDE. All patients were followed-up for 6 months after operation. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB) and total bilirubin (TBIL) levels were detected by using an automatic biochemical analyzer, and serum stress response indicators, such as adrenaline (A), adrenocorticotropic hormone (ACTH) and cortisol (COR) levels were assayed by radioimmunoassay. Results The operation time, intraperitoneal drainage time and hospital stay in the observation group were(91.3±12.6)min, (3.3±1.2)d and (5.9±1.2)d, significantly shorter than [(115.4±19.2)min, (4.5±1.4)d and (8.6±1.5)d, respectively, P＜0.05] in the control; there were no significant differences as respect to serum biochemical parameters between the two groups(P＞0.05); 3 days after operation, serum A, ACTH and COR levels in the observation were (1.2±0.3) nmol/L,(13.6±4.1)ng/mL and (212.9±21.4)ng/mL, all significantly lower than [(1.6±0.4)nmol/L, (17.2±4.8)ng/mL and (256.4±35.7)ng/mL, P＜0.05] in the control; at the end of six month follow-up, the post-operational complications in the observation was 9.3%, significantly lower than 29.0%(P＜0.05) in the control, while there was no significant difference respect to the postoperative stone recurrence in the two groups (2.3% vs. 6.5%, P>0.05). Conclusion The primary suture LCBDE is a good choice for patients with choledocholithiasis, which might relieve the postoperative stress reaction and reduce the risk of complications.

Key words: Choledocholithiasis, Laparoscopic common bile duct exploration, Primary suture, T-tube drainage, Stress response, Therapy

张福, 陈俊卯, 梁晓辉. LCBDE术一期缝合治疗胆总管结石患者效果研究^*[J]. 实用肝脏病杂志, 2023, 26(1): 128-131.

Zhang Fu, Chen Junmao, Liang Xiaohui. Efficacy of primary suture laparoscopic common bile duct exploration in the treatment of patients with choledocholithiasis[J]. Journal of Practical Hepatology, 2023, 26(1): 128-131.

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LCBDE术一期缝合治疗胆总管结石患者效果研究^*

Efficacy of primary suture laparoscopic common bile duct exploration in the treatment of patients with choledocholithiasis

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