胆总管一期缝合经胆囊管胆道置管外引流与T管引流的对比分析  

Comparative analysis of transcystic biliary drainage with primary suture of the common bile duct versus T tube drainage

作　　者：管辉球[1] 丁明金[1] 毛须平[1] 吴卫东[1] 蒋华[1] 徐锁青[1] 徐云霞 

机构地区：[1]丹阳市人民医院普通外科,江苏镇江212300

出　　处：《肝胆胰外科杂志》2017年第5期381-384,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：镇江市卫生科技重点项目(SHW2015021);镇江市社会发展科技计划项目(FZ2015073)

摘　　要：目的对比分析胆总管一期缝合经胆囊管胆道置管外引流与T管引流的临床疗效。方法回顾性分析2013年2月至2016年9月丹阳市人民医院112例腹腔镜治疗胆囊结石合并胆总管结石患者的临床资料。根据手术方法不同,患者分为两组:腹腔镜胆总管切开一期缝合经胆囊管胆道置管外引流组(A组,59例),腹腔镜胆总管切开T管引流组(B组,53例)。比较两组患者的手术时间、术后引流量、术后住院时间、术后恢复正常生活时间、术后并发症等情况。结果两组患者均顺利完成手术。与T管引流组比,经胆囊管胆道置管外引流组术后恢复正常生活时间明显缩短[(7.25±1.27)d vs(46.47±3.86)d,P<0.05],但手术时间[(133.75±14.51)min vs(132.21±12.71)min]、术后住院时间[(7.15±1.23)d vs(6.94±0.95)d],两组比较差异均无统计学意义(P>0.05)。两组患者引流量前2 d对比差异无统计学意义(P>0.05),2 d后经胆囊管胆道置管引流量较T管引流量明显减少(P<0.05)。两组患者均随访2~29个月,平均10个月,B超检查无胆管狭窄,肝功能均正常。结论经胆囊管胆道置管外引流较T管引流简易、微创,并有利于胆汁排入十二指肠,值得临床推广。objective To compare the clinical efficacy of transcystic biliary drainage with primary closure versus T tube drainage following laparoscopic choledochotomy.Methods Between Feb.2013 and Sep.2016,a total of 112 selected patients with cholecystolithiasis and choledocholithiasis underwent laparoscopic exploration in Danyang People＇s Hospital were retrospectively analyzed.Laparoscopic choledochotomy followed by primary duct closure with transcystic drainage performed in 59 patients,and T tube drainage in 53 patients.The operation time,volumn of bile drainage,duration of hospitalization,time of return to work and incidence of postoperative complications were compared between the two groups.Results The operations were successfully carried out in two groups.The time of return to work in the transcystic biliary drainage group was significantly shorter than that in the T tube drainage group [（7.25±1.27） d vs（46.47±3.86） d,P〈0.05].There was no significant difference in the operation duration [（133.75±14.51） min vs（132.21±12.71） min] and duration of hospitalization [（7.15±1.23） d vs（6.94±0.95） d] between two groups（P〈0.05）.The difference of quantity of bile drainage volumn was not significant in two groups at the first 2 d（P〈0.05）.After 2 d,the bile drainage volumn in the transcystic biliary drainage group was less than that in the T tube drainage group（P〈0.05）.No patients with postoperative biliary leakage complications were found.All patients were followed up for 2~29 mon,average 10 mon.B-ultrasound examination showed no biliary stricture,and liver function indexes were all normal.Conclusion The primary suture of the choledochotomy,and subsequent transcystic drainage is a simple and less invasive procedure than that of T tube placement,which is deserved to be romoted.

关 键 词：胆总管结石 腹腔镜 胆道引流 

分 类 号：R657.42[医药卫生—外科学]