腹腔镜下经胆囊管胆道探查术与腹腔镜下胆道探查“T”管引流治疗继发性肝外胆管结石比较

目的：比较分析腹腔镜下经胆囊管胆总管探查取石术（laparoscopic transcystic common bile duct ex-ploration，LTCBDE）与腔镜胆道探查“T”管引流（laparoscopic common bile duct exploration，LCBDE）2种术式治疗继发性肝外胆管结石的临床效果。方法选择2011年6月-2013年6月在新疆医科大学第一附属医院行腹腔镜胆总管探查取石术的58例继发性肝外胆管结石患者，分为两组，LTCBDE组26例，LCBDE组32例（其中2例为 LTCBDE组术中中转）。比较两组患者手术时间、术中出血量、住院费用、术后补液量、术后带管时间、术后住院时间及术后并发症（胆漏、胆总管狭窄、胆管炎、腹腔感染、胆道出血、残余结石）。结果两组患者手术均成功，治愈后出院，无死亡病例。LTCBDE组术后无胆漏、残余结石及胆道出血，LCBDE组术后出现1例胆漏、2例残余结石、1例胆道出血，两组均无术后胆总管狭窄、胆管炎及腹腔感染病例。LTCBDE组患者术后带管时间、住院费用、术中出血量、术后住院时间、术后补液量均少于LCBDE引流组，差异有统计学意义（P ＜0．05）；LTCBDE组手术时间长于 LCBDE组，差异有统计学意义（P ＜0．05）。结论在严格掌握手术适应证的条件下，LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点，可视为安全有效及经济的术式选择。

A comparative study of laparoscopic transcystic common bile duct exploration with laparoscopic transcystic common bile duct exploration for secondary extrahepatic bile duct stones

Objective To compare the secondary extrahepatic bile duct stones′treatment by laparoscopic transcystic common bile duct exploration （LTCBDE）with stent versus T-tube drainage after laparoscopic exploration.Methods Form June 2011 to June 2013,58 patients with secondary extrahepatic bile duct in our hospital clinical data of laparoscopic exploration were divided into two groups：LTCBDE group （26 ca-ses）;LCBDE group （32 cases）,in which there were two cases of intraoperative transit LTCBDE.Compar-ative indicators include：operation time,intra-operative blood loss,hospitalization expenses,postoperative rehydration volume,postoperative tube time,postoperative hospital stay and postoperative complications （bile leakage and bile duct stricture, cholangitis, abdominal cavity infection, biliary tract bleeding,residual stones）.Results Two groups of patients with operation were successful after treatment without death.LTCBDE group have no bile leakage ,residual calculi or biliary tract bleeding,LCBDE group have 1 cases of bile leakage,2 case of residual stones,1 case of biliary tract bleeding,and two groups had no bile duct stenosis,cholangitis and abdominal cavity infection.LTCBDE group with tube time,postoperative hospitalization expenses,intra-operative blood loss,postoperative hospital stay,less than the LCBDE group,two groups was statistically significant difference （P 〈0.05）;LTCBDE operation time was longer than the LCBDE group,and two groups were statistically significant difference （P 〈0.05）.Conclusion Under the condition of strictly grasp the operation indication,LTCBDE,compared with the LCBDE,has small trauma,less complications,low cost,high postoperative quality of life,and can be regarded as safe, effective and economic operation.