【摘要】 目的:探讨腹腔镜经胆囊管途径治疗胆囊结石合并胆总管结石的可行性与安全性。方法:回顾分析2015年1月至2017年1月152例胆囊结石合并胆总管结石患者的临床资料,其中66例经胆囊管行腹腔镜胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE),为LTCBDE组;86例经胆总管行腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE),为LCBDE组。统计分析两组患者一般情况、手术时间、术中出血量、腹腔引流时间、住院时间、住院总费用、并发症等指标。结果:两组均无中转开腹及死亡病例,手术时间差异无统计学意义(P>0.05),LTCBDE组术后住院时间、术后腹腔引流时间、住院费用、术后胆漏发生率优于LCBDE组(P<0.05)。LCBDE组中13例患者行T管引流,LTCBDE组均行胆总管一期缝合,差异有统计学意义(P<0.05)。结论:LTCBDE可避免术后T管引流,缩短了住院时间,术后并发症少,具有安全、经济、有效的微创优势。更多还原

【Abstract】 Objective: To evaluate the feasibility and safety of laparoscopic transcystic common bile duct exploration in the treatment of gallstones and common bile duct stones. Methods: A total of 152 patients who were diagnosed with gallstones and common bile duct stones from Jan. 2015 to Jan. 2017 were enrolled in the retrospective analysis study. Among them,66 cases were in laparoscopic transcystic common bile duct exploration( LTCBDE) group,while the other 86 cases were in laparoscopic common bile duct exploration( LCBDE) group. These patients were followed up for 6 months. Statistical analysis was performed on the general condition,operation time,intraoperative bleeding,intraperitoneal drainage time,hospitalization time,total cost of hospitalization and complications. Results: There were no conversions to laparotomy and no deaths in the two groups. The difference of operation time between LCBDE group and LTCBDE group was not statistically significant( P > 0. 05). The postoperative hospital stay and the time of intraperitoneal drainage were shortened,the cost of hospitalization was reduced,and postoperative bile leakage were lower in the LTCBDE group,and the differences were statistically significant( P < 0. 05). There were 13 patients in the LCBDE group who underwent T-tube drainage,while all of the patients in LTCBDE group had a primary ductal closure,and the difference was statistically significant( P < 0. 05). Conclusions:LTCBDE can avoid postoperative T-tube drainage,shorten hospital stay and reduce postoperative complications. It has the advantages of safety,economy and effectiveness in minimally invasive surgery.更多还原