Laparoscopic Common Bile Duct Exploration in Cirrhotic Patients With Choledocholithiasis
Laparoscopic Common Bile Duct Exploration in Cirrhotic Patients With Choledocholithiasis
复制标题
肝硬化胆总管结石患者的腹腔镜胆总管探查
DOI：
10.1097/mcg.0000000000000068
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发表时间：
2015
影响因子：
2.9
通讯作者：
Hong Wu
中科院分区：
文献类型：
--
作者：
J. Qiu;Hai;Shuting Chen;Hong Wu
背景和目标：虽然腹腔镜胆总管探查术（LCBDE）已成为大多数胆总管结石患者的标准手术，但该手术在肝硬化中的应用仍存在争议。本研究的目的是评价LCBDE在胆总管结石合并代偿期肝硬化患者中的可行性和安全性。患者和方法：从2006年1月至2012年12月，我院进行了346例LCBDE。根据既往定义的肝脏情况将患者分为A组（肝硬化，n=132）和B组（无肝硬化，n=214）。对两组的围手术期数据进行回顾性分析和比较。结果：326例患者成功完成LCBDE。20例患者（5.7%）需要从腹腔镜手术转为开放手术，主要原因是出血（5，25%）和严重粘连（8，40%）。211例患者（64.7%）置入T管，115例（35.3%）患者进行一期缝合。A组和B组术中失血量有显著差异（85 vs. 35 mL; P<0.01）。然而，两组在平均手术时间方面无显著差异（2.1 vs 1.9 h; P=0.07），并发症发生率（10.6% vs. 8.8%; P=0.6），平均住院时间（4.2 vs. 4.0 d; P=0.6）、转换率（5.3% vs. 6.1%; P=0.77）和胆总管结石残留率（8.3% vs. 7.1%; P=0.65）。两组均无死亡。结论：LCBDE是治疗代偿期肝硬化胆总管结石的一种安全、有效、可行的手术方法。
Background and Aims: Although laparoscopic common bile duct exploration (LCBDE) has become the standard procedure for most choledocholithiasis patients, the application of this procedure to liver cirrhosis is still in debate. The aim of the current study was to evaluate the feasibility and safety of LCBDE in choledocholithiasis patients with compensated liver cirrhosis. Patients and Methods: From January 2006 to December 2012, 346 LCBDEs were performed in our hospital. According to the previously defined liver condition, the patients were divided into group A (liver cirrhosis, n=132) and group B (without cirrhosis, n=214). The perioperative data for the 2 groups were retrospectively reviewed and compared. Results: LCBDE was successfully completed in 326 patients. Conversion from laparoscopic to open surgery was necessary for 20 patients (5.7%) mainly because of hemorrhage (5, 25%) and severe adhesions (8, 40%). A T-tube was placed in 211 patients (64.7%), and primary closure was performed in 115 (35.3%) patients. There was a significant difference for groups A and B in terms of intraoperative blood loss (85 vs. 35 mL; P<0.01). However, the 2 groups showed no significant differences with respect to the mean operation time (2.1 vs. 1.9 h; P=0.07), complication rates (10.6% vs. 8.8%; P=0.6), mean hospital stay (4.2 vs. 4.0 d; P=0.6), conversion rate (5.3% vs. 6.1%; P=0.77), and retained choledocholithiasis rate (8.3% vs. 7.1%; P=0.65). There was no mortality in both groups. Conclusions: LCBDE is a feasible, effective, and safe surgical procedure for choledocholithiasis patients with compensated cirrhosis.