腹腔镜胆总管切开取石一期缝合与T管引流治疗胆总管结石的临床疗效比较  

Comparison of clinical effects between primary duct closure and T-tube drainage during laparoscopic common bile duct exploration for patients with choledocholithiasis

作　　者：陆锦俊 孙跃明[2] 

机构地区：[1]海门市人民医院,江苏海门226100 [2]南京医科大学第一附属医院

出　　处：《腹腔镜外科杂志》2014年第12期912-916,共5页Journal of Laparoscopic Surgery

摘　　要：目的：比较腹腔镜胆总管切开取石一期缝合与T管引流治疗胆总管结石的临床疗效。方法：回顾分析2010～2012年为149例胆总管结石患者行腹腔镜胆总管切开取石术的临床资料,其中58例行一期缝合（缝合组）,91例放置T管引流（引流组）,对比分析两组手术时间、出血量、胃肠功能恢复时间、术后疼痛、住院费用、术后住院时间、术后恢复工作时间及术后相关并发症（腹腔感染、切口感染、胆漏、残余结石、术后胰腺炎、腹膜炎等）发生率。结果：两组手术均获成功。两组出血量、术后住院时间、术后并发症（胆漏、术后腹腔感染、残余结石、术后胰腺炎、腹膜炎）发生率差异均无统计学意义（P〉0.05）;一期缝合组手术时间平均（58.6±20.5）min,术后恢复肛门排气时间平均（13.2±2.4）h,术后疼痛药物使用率、切口感染率、平均住院费用、术后恢复工作时间明显优于T管引流组（P〈0.05）。结论：腹腔镜胆总管切开取石一期缝合治疗胆总管结石较T管引流具有更好的临床疗效,但一期缝合的技术要求更高,胆道镜取石技术、缝合技术是关键。术者具备熟练的操作技术,严格掌握手术适应证,腹腔镜胆总管切开取石后一期缝合可缩短患者康复时间,提高围手术期生存质量,是较T管引流治疗胆总管结石更理想的术式。Objective： To compare the clinical effects of primary duct closure and T-tube drainage in laparoscopic common bile duct exploration（ LCBDE）. Methods： The clinical data of 149 patients with choledocholithiasis performed LCBDE from Jan. 2010 to Dec. 2012 were collected and analyzed retrospectively. Patients in group A received primary duct closure and others in group B received T-tube drainage after LCBDE. Comparative studies on operative time,blood loss,the first exhaust time,postoperative pain,outlay,hospital stay,the time getting well and the postoperative complications such as intra-abdominal infections,surgical site infection,bile leakage,remnants stones,postoperative pancreatitis and peritonitis were made. Results： LCBDE was performed successfully in 149 cases. 58 patients received primary duct closure（ Group A） and 91 patients received T-tube drainage（ Group B）. There were no differences between two groups on blood loss,postoperative hospital stay and the postoperative complications such as bile leakage,intra-abdominal infections,remnants stones,postoperative pancreatitis and peritonitis（ P〉0. 05）. Group A was superior to Group B on operative time[（ 58. 6 ± 20. 5） min],the first exhaust time [（ 13. 2 ± 2. 4） h],analgesics usage（ 3 /58）,surgical site infection（ 0 /58）,outlay[（ 13 302 ± 2 200） RMB]and the time getting well [（ 16. 3 ± 5. 3） d]（ P〈0. 05）. Conclusions： Primary duct closure in LCBDE has preferably clinical efficacy than T-tube drainage. The technical requirements of primary duct closure is higher,the choledochoscopic calculi removal and suture are the key for this procedure,thus surgeons should master proficient skills and strictly control operative indications. Primary duct closure in LCBDE can shorten the time getting well and increase perioperative quality of life,thereby is worthy of clinical promotion and application

关 键 词：胆总管结石 腹腔镜检查 一期缝合 T管引流 

分 类 号：R657.4[医药卫生—外科学]