三镜联合胆道支架胆总管一期缝合治疗肝外胆管结石的临床研究

A clinical study of three endoscopies combined with biliary stenting and primary closure of the common bile duct in treatment of choledocholithiasis

摘要:

目的：探讨三镜联合胆道支架胆总管一期缝合治疗肝外胆管结石的临床疗效。方法：采用回顾性队列研究方法，收集重庆市人民医院2013年1月至2016年1月收治的380例肝外胆管结石病人的临床资料。按照治疗方式的不同，126例纳入T管引流组，124例纳入一期缝合组，130例纳入三镜联合支架组。比较3组手术时间、术后住院时间、住院费用、胆道并发症发生率及术后肝功情况等方面的差异。3组病人术后定期接受门诊及电话方式随访，随访时间截至2018年1月。结果：①治疗结果：T管引流组、一期缝合组和三镜联合支架组的手术时间分别为（106.66±5.01）、（105.52±5.62）和（105.50±6.10） min，3组比较无统计学差异（P ＞0.05）。T管引流组、一期缝合组和三镜联合支架组的术后住院时间分别为（7.91±0.83）、（7.85±0.70）和（5.69±0.77）d，3组比较三镜联合支架组明显短于T管引流组和一期缝合组（P＜0.05）。T管引流组、一期缝合组和三镜联合支架组的住院费用分别为（22 081.43±687.55）、（21 930.73±758.35）和（19 560.88±828.61）元，3组比较三镜联合支架组明显少于T管引流组和一期缝合组（P＜0.05）。在胆道并发症发生率上，T管引流组术后出现胆漏2例，一期缝合组胆漏3例，三镜联合支架组没有胆漏出现，3组比较无统计学差异（P ＞0.05）。3组病人的肝功能在术后5～7 d逐渐恢复正常，三镜联合支架组和T管引流组术后肝功恢复情况相近，比一期缝合组快，差异有统计学意义（P＜0.05）。②随访结果：380例病人中，364例获得随访，随访时间为1～24个月，中位随访时间为20个月。病人恢复情况良好，无腹痛、黄疸症状，未见结石复发及胆管狭窄。结论：三镜联合胆道支架胆总管一期缝合治疗肝外胆管结石安全可行。

Abstract:

Objective：To investigate the clinical efficacy of three endoscopies combined with biliary stenting and primary closure of the common bile duct in the treatment of choledocholithiasis. Methods：A retrospective cohort study was performed on the clinical data of 380 patients with choledocholithiasis who were admitted to our hospital from January 2013 to January 2016. According to treatment methodology，126 patients were assigned to T-tube drainage group，124 patients to primary closure group，and 130 patients to three endoscopies combined with stenting group. The operation time，postoperative hospital stay，hospitalization cost，incidence of biliary complications，and postoperative liver function were compared between the three groups. Follow-up was regularly performed after surgery by outpatient clinic and telephone interview until January 2018. Results：①Treatment outcomes：there was no significant dif－ference in operation time between the T-tube drainage group，primary closure group，and three endoscopies combined with stenting group（106.66±5.01 vs. 105.52±5.62 vs. 105.50±6.10 min，P >0.05）. The T-tube drainage group and the primary closure group had significantly longer postoperative hospital stay and higher hospitalization cost than the three endoscopies combined with stenting group（7.91±0.83），（7.85±0.70） vs. （5.69±0.77） d，P <0.05；（22 081.43±687.55），（21 930.73±758.35） vs. （19 560.88±828.61） yuan，P<0.05. There was no significant difference in the incidence of bile leaking between the three groups（2 vs. 3 vs. 0 case，P >0.05）. In the three groups，liver function gradually re－covered within 5 to 7 days after surgery. The three endoscopies combined with stenting group and the T-tube drainage group showed similar recovery of liver function，which was significantly faster than that in the primary closure group（P <0.05）. ②Follow-up results：in the 380 patients，364 were followed up for 1 to 24 months. The median follow-up time was 20 months. Patients recovered well and no abdominal pain，jaundice，residual stones，or bile duct stricture was observed. Conclusion：Three endoscopies combined with biliary stenting and primary closure of the common bile duct is safe and feasible in the treatment of choledocholithiasis.