引流与修补治疗术中胆总管下段损伤的效果比较  

Surgical drainage versus repair in the treatment of distal common bile duct injury

作　　者：周俊晶[1] 赵长勇[1] 徐松[1] 张勇[1] 戴赛民[1] 郭子健[1] Zhou Junjing;Zhao Changyong;Xu Song;Zhang Yong;Dai Saimin;Guo Zijian(Department of Hepatobiliary Surgery,Affiliated Hospital of Jiangnan University,Wuxi 214062,Jiangsu Province,China)

机构地区：[1]江南大学附属医院肝胆外科,江苏无锡214062

出　　处：《中华肝胆外科杂志》2018年第11期757-760,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的比较外科引流与修补治疗术中胆总管下段损伤的效果，探讨胃胆管引流对术中胆总管下段损伤的治疗价值。方法比较我院收治的24例胆总管下端损伤引流组（17例）与修补组（7例）患者临床资料，包括术后第三天胃胆管引流量、腹腔引流管引流量、术后胃肠功能恢复时间、术后胃胆管带管时间、术后住院天数等。结果修补组与引流组术后第三天胃胆管引流量[（310.0±1122.0）比（264.0±144.0）ml]、腹腔引流管引流量[（42.0±25.0）ml比（125.0±195.0）ml]，差异均无统计学意义（均P〉0.05）。引流组患者术后胃肠功能恢复时间（3.0±1.5）d比（4.7±2.0）d）、术后胃胆管带管时间（7.5±1.0）d比（12.7±5.4）d、术后住院天数（9.5±1.5）d比（15.1±5.6）d,显著缩短，差异均有统计学意义（P〈0.05）。两组患者术后随访，均未发生胆道狭窄及胆管炎。结论单纯胃胆管引流治疗医源性胆总管下段损伤疗效确切，方法简单，较传统修补法术后恢复更快，有利于术后快速康复。Objective To compare the efficacy of surgical drainage versus repair in the treatment of iatrogenic injury of the distal common bile duct detected during operation, and to evaluate the effect of gastrobiliary duct drainage.Methods Patients with iatrogenic choledochal injury were divided into two groups： the drainage group （n=17） and the repair group （n=7）. Data on the amounts of postoperative biliary and abdominal cavity drainage, gastrointestinal function recovery, the duration of biliary drainage and hospitalization were compared.Results When compared with the repair group, there were no significant differences in the amounts of postoperative biliary drainage [（310.0±112.0） vs. （264.0±144.0）ml] and abdominal cavity drainage [（42.0±25.0）ml vs. （125.0±195.0）ml）] （both P〉0.05）. However, gastrointestinal function recovery [（3.0±1.5）d vs. （4.7±2.0）d], durations of biliary drainage [（7.5±1.0）d vs. （12.7±5.4）d] and hospitalization [（9.5±1.5）d vs. （15.1±5.6）d] of the drainage group were significantly shorter than the repair group （P〈0.05）. No biliary strictures of cholangitis were detected in the two groups.Conclusion When compared with traditional repair, gastrobiliary drainage was a simpler, safer, and more effective therapeutic strategy for patients with iatrogenic distal common bile duct injury, and with a quicker recovery after treatment.

关 键 词：胆总管下段 医源性损伤 胃胆管引流 

分 类 号：R657.4[医药卫生—外科学]