胆总管探查术后胆管内支架引流与T管引流的临床比较研究  

Clinical comparative study between biliary stent insertion drainage and T-tube drainage after common choledochotomy

作　　者：王健[1] 张文伟[1] 黄滨[1] 曹天生[1] 林波[1] 陈浩[1] 孟津[2] 许荣华[2] 

机构地区：[1]广东省广州市花都区人民医院,南方医科大学附属花都医院,广州510800 [2]海南省海南医学院附属医院,海口570102

出　　处：《广州医药》2016年第1期38-41,共4页Guangzhou Medical Journal

基　　金：广东省科技厅社会发展科技计划项目(2012B020700004);海南省卫生厅医学科研基金项目(琼卫2013资助-003号)

摘　　要：目的比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P<0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P>0.05)。结论内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration （OCBDE）, the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group （ P 〈 0. 05 ） ; There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone （P 〉 0. 05 ） . Conclusion Endoscopic retrograde biliary drainage （ERBD） with primary closure after eholedoehotomy is a safe, effective and feasible procedure for the management of eholedocholithiasis, it can significantly reduce the postoperative hospital stay and im- prove the life quality of patients and expand the indications for primary closure of CBD incision.

关 键 词：胆总管探查 T管 一期缝合 胆道支架内引流术 

分 类 号：R657.4[医药卫生—外科学]