“单孔+1”与传统多孔腹腔镜胆总管切开取石术的疗效与安全性比较

Comparison of single-incision plus one-port versus conventional muti-port laparoscopic common bile duct exploration

摘要:

背景与目的 腹腔镜胆总管切开取石术（LCBDE）是胆总管结石的主要微创治疗方式。“单孔+1”腹腔镜技术（SILS+1）在胆囊手术中已显示出微创优势，但其在胆总管切开取石中的安全性与有效性仍有争议。本研究在统一应用吲哚菁绿（ICG）荧光胆管显影及自脱落胆道支架条件下，比较SILS+1与传统多孔LCBDE的围手术期疗效与安全性。方法 回顾性分析2024年3月—2025年3月接受LCBDE治疗的132例胆总管结石患者，根据手术方式分为SILS+1组（n=32）与传统多孔组（n=100）。采用倾向性评分匹配后纳入SILS+1组32例、传统多孔组64例。比较两组术中指标、术后恢复、并发症发生率及美容满意度等。结果 两组手术时间及胆管缝合时间差异无统计学意义（均P>0.05）。SILS+1组标本取出时间更短，切口总长度更小，术后24 h疼痛评分更低，腹壁美容满意度更高（均P<0.001）。两组在术中出血量、住院时间、住院费用及并发症发生率方面差异无统计学意义（均P>0.05）。所有胆汁漏患者经保守治疗恢复，无需再次手术；两组均无残余结石及支架相关并发症。结论 在统一ICG荧光导航及胆道自脱落支架辅助条件下，SILS+1 LCBDE在不增加并发症发生风险的前提下，可进一步减少手术创伤、减轻术后疼痛并改善美容效果，是一种安全、可行的微创手术方式，但其长期疗效仍需进一步研究验证。

Abstract:

Background and Aims Laparoscopic common bile duct exploration (LCBDE) is a standard minimally invasive approach for choledocholithiasis. Although single-incision plus one-port laparoscopy (SILS+1) has demonstrated advantages in cholecystectomy, its safety and efficacy in common bile duct exploration remain unclear. This study aimed to compare perioperative outcomes between SILS+1 and conventional multi-port LCBDE under standardized adjunctive conditions including indocyanine green (ICG) fluorescence cholangiography and spontaneous biliary stent placement.Methods A retrospective analysis was conducted on 132 patients who underwent LCBDE between March 2024 and March 2025. Patients were divided into a SILS+1 group (n=32) and a conventional multi-port group (n=100). After propensity score matching, 32 patients in the SILS+1 group and 64 in the control group were included. Perioperative outcomes, postoperative recovery, complications, and cosmetic satisfaction were compared.Results There were no significant differences in operative time or bile duct suturing time between the two groups (both P>0.05). The SILS+1 group showed significantly shorter specimen extraction time, reduced total incision length, lower 24 h postoperative pain scores, and higher cosmetic satisfaction (all P<0.001). No significant differences were observed in intraoperative blood loss, hospital stay, total cost, or complication rates. All bile leakage cases were successfully managed conservatively without reoperation. No retained stones or stent-related complications were observed.Conclusion Under standardized adjunctive conditions, SILS+1 LCBDE is a safe and feasible technique that reduces surgical trauma, alleviates postoperative pain, and improves cosmetic outcomes without increasing complication rates. Further multicenter studies with long-term follow-up are needed to validate its clinical benefits.