腹腔镜胆总管探查Ⅰ期缝合对T管引流术后胆道压力及效果分析  

Analysis of the bile duct pressure and effect after laparoscopic common bile duct exploration with primary closure of T tube biliary drainage

作　　者：王国军 马国峰 沈华强 

机构地区：[1]浙江省绍兴市中心医院,绍兴312030

出　　处：《浙江创伤外科》2017年第1期5-8,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的分析腹腔镜胆总管探查Ⅰ期缝合对T管引流术后胆道压力及效果。方法选择2015年1月至2016年5月本院68例胆总管结石患者作为研究对象,按照随机数表法分为观察组和对照组,每组34例。观察组行腹腔镜胆总管探查Ⅰ期缝合,对照组行腹腔镜胆总管探查+T管引流。比较两组患者各时间点胆道压力、手术时间、术中出血、术后肛门排气时间、下床活动时间、术后带管时间、住院时间、术后补液量、住院费用以及术后并发症。结果两组患者术中胆道压力差异不明显,比较无统计学意义(P>0.05);观察组患者术后第1天、第3天、第5天胆道压力(14.52±2.26 cm H_2O、12.13±2.34 cm H_2O、11.49±1.52 cm H_2O)显著高于对照组(11.18±2.79 cm H_2O、10.58±2.25 cm H_2O、9.05±2.14cm H_2O),比较差异有统计学意义(P<0.05);观察组手术时间、术中出血量较对照组差异不显著,比较无统计学意义(P>0.05);观察组术后肛门排气时间、下床活动时间、术后带管时间、住院时间、术后补液量、住院费用(28.28±8.61小时、15.07±4.11小时、3.07±1.17天、6.07±1.31天、5286.07±941.36 ml、13566.87±941.28元)均少于对照组(42.52±12.73小时、29.53±5.21小时、3.93±1.26天、7.33±2.32天、8397.59±982.47 ml、20047.54±832.41元),比较差异有统计学意义(P<0.05);观察组患者术后胆漏、胆管狭窄、结石残留、胆道出血术后总并发症率(5.88%)低于对照组(23.53%),差异具有统计学意义(P<0.05)。结论在严格把控腹腔镜胆总管切开探查术及术后Ⅰ期缝合适应证的条件下,腹腔镜胆总管探查Ⅰ期缝合较T管引流更加安全、有效,缩短了住院时间,减轻了患者的经济负担,值得推广应用。Objective To analyze the bile ductpressure and effectafter laparoscopic common bile duct exploration with primary closure or T tube biliary drainage. Methods 68 cases with common bile duct stone from January 2015 to May 2016 in our hospital were selected as research subjects, and divided into observation group and control group according to the table of random numbers, 34 cases in each. The patients in the observation group were received laparoscopic common bile duct exploration with primary closure, in the control group were received laparoscopic common bile duct exploration with T tube drainage. The data of biliary tract pressure, operation time, blood loss, postoperative anal exhaust time, ambulation time, with a tube after time, hospital stay, postoperative rehy- dration, hospital costs and postoperative complications were compared. Results There were no significant differences in intraoperative bile duct pressure （P〉0.05）; and in the observation group on day 1, day 3, day 5 biliary pressure （14.52 ±2.26 cmH20, 12.13 ± 2.34 cmH20, 11.49±1.52 cmH2O） was significantly higher than that in the control group （11.18 ±2.79 cmH2O, 10.58 ＋ 2.25 cmH20, 9.05±2.14 cmH20）, the difference was statistically significant （P〈0.05）.The operation time, blood lossin the observation group compared to that inthe control group, the difference was not significant difference （P〉0.05）;）. The anal exhaust time, ambulation time, with a tube after time, hospital stay, postoperative fluid volume, cost of hospitalization （28.28 ±8.61h, 15.07 ±4.11 h, 3.07±1.17d, 6.07± 1.31 d, 5286.07 ± 941.36 mL, 13566.87±941.28 Yuan）in the observation group were less than those in the control group （42.52 ±12.73 h, 29.53±5.21 h, 3.93±1.26 d, 7.33±2.32 d, 8397.59±982.47 mL, 20047.54 ±832.41 Yuan）, the difference was statistically significant （P〈0.05）.patients The bile leakage, bile duct stricture, calculus remained hemobilia total postoperative complication rate （5.88%） in the observation grou

关 键 词：腹腔镜胆总管探查术 胆总管结石 Ⅰ期缝合 T管引流 

分 类 号：R657.4[医药卫生—外科学]