腹腔镜下经胆囊管胆总管结石取出术有效性及安全性的临床研究-东南大学学报医学版

腹腔镜下经胆囊管胆总管结石取出术有效性及安全性的临床研究

单位：1. 江苏省高邮市人民医院肝胆外科, 江苏高邮 225600;
2. 江苏省盱眙县人民医院麻醉科, 江苏盱眙 211700

分类号：R657.42;R616.5

出版年·卷·期（页码）：2025·44·第五期（757-763）

摘要：

目的:探讨腹腔镜下经胆囊管胆总管结石取出术(TC-CBDE)的临床效果及安全性。方法:本研究为回顾性研究,纳入2020年1月至2023年12月期间接受TC-CBDE患者129例和接受腹腔镜下胆总管探查术(LCBDE)患者76例,比较两组患者术前影像学检查结果、血清学检查结果、手术相关指标、并发症发生率及术后恢复情况。结果:接受TC-CBDE的患者平均手术时间为45 min,较LCBDE组患者的53 min明显缩短(P<0.05),TC-CBDE组患者平均术中出血量较LCBDE组患者明显减少(12 mL vs. 15 mL,P<0.05),TC-CBDE组患者中位术后住院时间为5 d,较LCBDE组患者缩短3 d(P<0.05)。尽管两组患者术后发生胆瘘、腹腔出血、胆管狭窄、胰腺炎、结石再复发等并发症的发生率无明显差异,但TC-CBDE呈现更低的趋势。结论: 对于术前评估胆囊管条件良好(直径≥4 mm)且无急性胆囊炎的胆总管结石患者,TC-CBDE是一种安全有效的手术方法,具有创伤小、恢复快的优点,值得临床推广应用。

Objective: To investigate the clinical efficacy and safety of transcystic common bile duct exploration(TC-CBDE) for choledocholithiasis. Methods: A total of 129 patients undergoing TC-CBDE and 76 patients undergoing laparoscopic common bile duct exploration(LCBDE) between January 2020 and December 2023 were retrospectively enrolled in this study. Preoperative imaging and serological findings, surgical-related indicators, complication rates, and postoperative recovery were compared between the two groups. Results: The mean operative time in the TC-CBDE group was 45 min, significantly shorter than the 53 min in the LCBDE group(P<0.05). Intraoperative blood loss was significantly reduced in the TC-CBDE group compared to the LCBDE group(12 mL vs. 15 mL, P<0.05). The median postoperative hospital stay in the TC-CBDE group was 5 d, shortened by 3 d than the LCBDE group(P<0.05). Although no significant differences was observed in the incidence rates of postoperative complications,including biliary leakage, intra-abdominal hemorrhage, biliary stricture, pancreatitis, and stone recurrence between the two groups, TC-CBDE demonstrated a trend toward lower complication rates. Conclusion: For patients with choledocholithiasis who meet preoperative criteria of favorable cystic duct anatomy(diameter≥4 mm) and absence of acute cholecystitis, TC-CBDE demonstrates safety and efficacy as a surgical approach. Compared to LCBDE, TC-CBDE offers advantages of a minimally invasive nature and rapid postoperative recovery, warranting wider clinical adoption.

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