腹腔镜胆囊切除联合胆总管取石术后胆管一期缝合与T管引流的疗效对比  

Curative effect of primary suture of bile duct versus T tube drainage in laparoscopic cholecystectomy combined with common bile duct exploration:a comparative study

作　　者：张玉华[1] 王宇[1] 张峰[1] 吕谦[1] 史宪杰[2] 

机构地区：[1]鞍山市中心医院普外科,辽宁鞍山114001 [2]解放军总医院肝胆外科,北京100853

出　　处：《解放军医学院学报》2017年第2期111-114,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的比较腹腔镜胆囊切除联合胆总管探查取石后胆管一期缝合与T管引流的疗效。方法采用前瞻性研究,将2014年1月-2016年1月就诊于鞍山市中心医院普外科一病区的胆囊结石合并胆总管结石患者76例随机分为一期缝合组和T管引流组,比较两组手术情况、术后恢复及并发症等相关情况的差异。结果两组患者性别、年龄、血常规检测等指标上无统计学差异(P>0.05);一期缝合组平均手术时间、术后排气时间、术后住院时间及住院费用分别为(126.3±27.4)min、(2.3±0.4)d、(6.5±1.4)d、(23.3±6.5)k,均显著低于T管引流组的(142.3±38.7)min、(2.7±0.6)d、(7.9±1.8)d、(27.8±8.1)k(P<0.05);一期缝合组术后胆漏及高淀粉酶血症的发生率分别为8.6%、17.1%,低于T管引流组的10.5%及28.9%,但差异无统计学意义。此外,一期缝合组患者的远期并发症发生率为11.4%,低于T管引流组的26.3%,但差异无统计学意义(P=0.188)。一期缝合组治疗满意率为88.6%,T管引流组为65.8%,两组间差异有统计学意义(P=0.043)。结论腹腔镜胆囊切除联合胆总管探查取石后胆管一期缝合具有创伤小、康复快等优点。Objective To explore the curative effect of primary suture of bile duct versus T tube drainage in laparoscopic cholecystectomy combined with common bile duct exploration.Methods A prospective study was carried out to enroll 76 patients with cholecystolithiasis and choledocholithiasis in our hospital from January 2014 to January 2016, and the patients were randomly divided into primary suture group and T tube drainage group.The differences in intraoperative data, postoperative recovery and complications were compared between the two groups.Results No significant differences were shown in gender, age, blood test and other indicators of the two groups（P〉0.05）.The mean operating time, time to first flatus, postoperative hospitalization time and hospitalization expenses of primary suture group were（126.3±27.4） min,（2.3±0.4） d,（6.5±1.4） d,（23.3±6.5） thousand respectively, which were significantly lower than（142.3±38.7） min,（2.7±0.6） d,（7.9±1.8） d,（27.8±8.1） thousand in the T tube drainage group（P〈0.05, respectively）.The incidence of bile leakage and hyperamylasemia after surgery of primary suture group were 8.6% and 17.1% respectively, which were lower than 10.5% and 28.9% in the T tube drainage group, but the difference was not statistically significant.In addition, the long-term complication rates of primary suture group was 11.4%, which was lower than 26.3% in the T tube drainage group with no statistical significant difference（P=0.188）.While the treatment satisfaction rate of primary suture group was 88.6%, which was significantly higher than 65.8% in the T tube drainage group（P=0.043）.Conclusion Primary duct suture in laparoscopic cholecystectomy combined with common bile duct exploration can benefit patients by minimizing trauma, quick recovery, etc.

关 键 词：胆囊结石合并胆总管结石 腹腔镜手术 一期缝合 T管引流 

分 类 号：R657.42[医药卫生—外科学]