日间腹腔镜胆囊切除术中经胆囊管胆道镜探查联合汇入部微切开或球囊扩张的临床分析

doi:10.16139/j.1007-9610.2025.04.08

摘要/Abstract

摘要：

目的：探讨日间腹腔镜胆囊切除术中经胆囊管胆道镜探查（LTCBDE）联合汇入部微切开或球囊扩张的安全性与有效性。方法：回顾性分析2021年6月至2024年6月首都医科大学附属北京友谊医院203例行日间LTCBDE病人的临床资料。根据术式分为观察组（59例，包括汇入部微切开42例、胆囊管球囊扩张17例）与常规组（144例）。对比两组基线特征、术中探查结果、手术时间、术后恢复及并发症等指标。结果：观察组术前胆管炎或胰腺炎病史（P<0.001）及总胆红素水平显著高于常规组（P=0.035）。观察组手术时间较长（P=0.014）、手术花费较多（P=0.001），但术中出血及术后离院时间两组差异无统计学意义，术后均无严重并发症发生。结论：在严格筛选病人的前提下，日间LTCBDE术中联合汇入部微切开或球囊扩张可有效解决胆道镜进镜困难问题，具有较高的安全性和探查彻底性。两种技术为日间胆道探查提供了可行的微创解决方案。

关键词: 日间手术, 胆道镜, 经胆囊管, 汇合部微切开, 球囊扩张

Abstract:

Objective To investigate the safety and efficacy of combined confluence microdissection or balloon dilatation followed by laparoscopic transcystic common bile duct exploration (LTCBDE) in day surgery laparoscopic cholecystectomy. Methods The clinical data of 203 patients with day surgery laparoscopic cholecystectomy combined with LTCBDE from June 2021 to June 2024 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. They were divided into an observation group (59 cases, including 42 cases of confluent microdissection and 17 cases of balloon dilatation) and a conventional group (144 cases) according to the surgical technique used. Baseline characteristics, intraoperative exploration results, operation time, postoperative recovery and complications were compared between the two groups. Results The history of preoperative cholangitis or pancreatitis (P<0.001) was more common in the observation group. And total bilirubin level was significantly higher in the observation group than in the conventional group (P=0.035). The observation group had a longer operative time (P=0.014) and higher hospitalization costs (P=0.001), but there was no difference in intraoperative bleeding and postoperative discharge time. There were no serious postoperative complications in either group. Conclusions Under the premise of strict patient screening, day surgery LTCBDE combined with confluence microdissection or balloon dilatation can effectively solve the problem of difficult choledochoscopic access, with high safety and thoroughness of exploration. Both techniques provide a feasible minimally observation solution for day surgery biliary exploration.

Key words: Day surgery, Choledochoscopy, Transcystic duct, Confluence microdissection, Balloon dilatation

中图分类号:

R657.42

吴鸿伟, 佟奎南, 李浩楠, 汪栋, 刘坤, 郭伟. 日间腹腔镜胆囊切除术中经胆囊管胆道镜探查联合汇入部微切开或球囊扩张的临床分析[J]. 外科理论与实践, 2025, 30(04): 339-344.

WU Hongwei, TONG Kuinan, LI Haonan, WANG Dong, LIU Kun, GUO Wei. Clinical analysis of laparoscopic transcystic common bile duct exploration combined confluence microdissection or balloon dilatation at the cystic duct in day surgery laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 339-344.

图/表 2

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Characteristics		Observation group（n=59）	Conventional group（n=144）	F/χ²/Z value	P value
Gender
	Male	24(40.7)	62(43.1)	χ²=0.097	0.756
	Female	35(59.3)	82(56.9)	χ²=0.097	0.756
Age（year）		45.75±13.00	49.30±8.03	F=42.556	0.055
BMI（kg/m²）		24.81±2.63	24.67±3.80	F=4.341	0.770
History of pancreatitis or cholangitis		21（35.6）	8（5.6）	χ²=96.718	<0.001
Preoperative ALT（U/L）		28（18，55）	29（20，38）	Z=-0.444	0.657
Preoperative ALP（U/L）		91（74，129）	87（69，119）	Z=-0.876	0.381
Preoperative GGT（U/L）		71（28，187）	89（61，117）	Z=-0.475	0.635
Preoperative TB（μmol/L）		14.60（10.65，18.49）	12.66（9.63，16.69）	Z=-2.113	0.035
Results of exploration
	Bile sludge	16(27.1)	20(13.9)	χ²=5.050	0.080
	Stone	25(42.4)	74(51.4)	χ²=5.050	0.080
Operative duration（min）		90（75，105）	80（75，95）	Z=-2.453	0.014
Intraoperative bleeding（mL）		15（10，20）	15（10，20）	Z=-0.485	0.628
Expenses（Yuan）		17 264.00（16 114.00，18 135.00）	16 557.00（15 448.75，17 455.00）	Z=-3.426	0.001
Length of hospital stay（h）		4（4，4）	4（4，4）	Z=-0.621	0.535