安徽省合肥市第二人民医院 肝胆外科，安徽 合肥 230011
李良， Email: email@example.com
Department of Hepatobiliary Surgery, Hefei Second People's Hospital, Hefei 230011, China
背景与目的 腹腔镜下经胆囊管胆总管探查取石术（LTCBDE）已被报道在择期手术中是安全有效的，但在急诊手术中的疗效尚未得到证实。因此，本研究探讨急诊LTCBDE治疗胆囊结石合并胆总管结石患者的安全性和可行性。方法 回顾性分析87例于2016年1月—2020年10月在合肥市第二人民医院接受LTCBDE治疗的胆囊结石合并胆总管结石患者的临床资料，其中37例急诊行LTCBDE治疗（急诊组），50例行择期LTCBDE治疗（择期组）。比较两组患者的一般基线资料、围手术期资料和随访资料。结果 两组患者的临床基线资料差异无统计学意义（均P>0.05）。两组均无中转开腹病例，均顺利完成腹腔镜手术。87例患者中72例顺利完成LTCBDE，15例改行胆总管切开完成探查取净石后行胆总管一期缝合。急诊组和择期组中分别有29例（78.4%）、43例（86.0%）完成经胆囊管探查，两组探查成功率差异无统计学意义（P=0.352）。与择期组比较，急诊组的手术时间延长（P=0.015）、术中出血量增加（P=0.014），其他围手术期指标差异均无统计学意义（均P>0.05）。两组共发生并发症6例，其中急诊组4例（2例胆汁漏、1例腹腔积液和1例结石残留）、择期组共2例（2例胆汁漏），两组的总并发症发生率及各单独并发症发生率差异均无统计学意义（均P>0.05）。结论 急诊LTCBDE与择期手术相比疗效相似，在选择合适的病例的前提条件下，急诊LTCBDE治疗胆囊结石合并胆总管结石患者是安全可行和有效的。
Background and Aims Laparoscopic transcystic common bile duct exploration (LTCBDE) has been reported to be safe and effective in elective surgery, but its efficacy in emergency surgery has not been established. Therefore, this study was conducted to evaluate the safety and feasibility of emergency LTCBDE in the treatment of patients with cholecystolithiasis complicated with choledocholithiasis.Methods The clinical data of 87 patients with gallbladder stones and concomitant common bile duct stones who underwent LTCBDE in Hefei Second People's Hospital from January 2016 to October 2020 were retrospectively analyzed. Of the patients, 37 cases underwent emergency LTCBDE (emergency group), and 50 cases underwent elective LTCBDE (elective group). The general baseline data, and perioperative variables and follow-up results between the two groups of patients were compared.Results There were no significant differences in baseline data between the two groups of patients (all P>0.05). No open conversion was needed in both groups, and laparoscopic surgery was successfully performed in all cases. Of the 87 patients, LTCBDE was successfully completed in 72 case, and 15 cases were converted to conventional laparoscopic common bile duct exploration with primary closure after failure of LTCBDE. LTCBDE was successfully completed in 29 cases (78.4%) in emergency group and 43 cases (86.0%) in elective group, respectively, and there was no statistical difference in exploration success rate between the two groups (P=0.352). In emergency group compared with elective group, the operative time was prolonged (P=0.015) and intraoperative blood loss was increased (P=0.014), while all other perioperative variables showed no statistical difference (all P>0.05). Complications occurred in 6 patients in the two groups, including 4 cases in emergency group (2 cases of bile leakage, 1 case of abdominal fluid collections and 1 case of retained stones) and 2 cases in elective group (2 cases of bile leakage). There were no significant differences in the overall incidence of complications and incidence of each specific complication between the two groups (all P>0.05).Conclusion Emergency LTCBDE has the comparable efficacy to elective LTCBDE. On the premise of appropriate selection of patients, emergency LTCBDE is safe and effective in the treatment of patients with gallbladder stones and concomitant common bile duct stones.