腹腔镜胆总管探查一期缝合术中输尿管导管内引流的临床应用价值  

Clinical Value of Ureteral Catheter Internal Drainage in Primary Suture of Laparoscopic Common Bile Duct Exploration

作　　者：汪旭[1] 金琦智 尹树君 马玉靖[1,2] 董科 Wang Xu;Jin Qizhi;Yin Shujun;Ma Yujing;Dong Ke(Department of Hepatobiliary Surgery,Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital,Chengdu 610072,China;Zunyi Medical College,Zunyi 563003,China)

机构地区：[1]四川省医学科学院.四川省人民医院肝胆外科,成都610072 [2]遵义医学院,遵义563003

出　　处：《成都医学院学报》2019年第1期100-102,106,共4页Journal of Chengdu Medical College

摘　　要：目的探讨腹腔镜胆总管探查取石一期缝合术中应用输尿管导管内引流治疗胆囊结石合并胆总管结石的临床疗效,比较与常规一期缝合的优劣。方法选取2015年4月至2017年5月四川省医学科学院·四川省人民医院收治的53例胆囊结石合并胆总管结石患者,随机分为试验组(n=26)和对照组(n=27),对照组行腹腔镜胆囊切除术+胆总管探查一期缝合,试验组在对照组的基础上加行输尿管导管内引流术。结果 53例患者均顺利实施手术,试验组发生切口感染1例,胰腺炎1例,总体并发症发生率为7.69%;对照组发生术后胆漏1例,腹腔感染1例,胰腺炎1例,总体并发症发生率为11.11%。试验组术后住院时间短于对照组,差异有统计学意义(P<0.05);试验组住院费用低于对照组,差异有统计学意义(P<0.05);两组手术时间、术中出血量、术后首次排气时间及相关术后并发症比较,差异无统计学意义(P>0.05)。结论对于胆囊结石合并胆总管结石的患者,行腹腔镜胆囊切除+胆总管探查取石一期缝合+输尿管导管内引流术是安全有效的,扩大了胆总管一期缝合的适应症,缩短术后住院时间,节省住院费用,并且不会增加术后并发症发生率。Objective To explore the clinical efficacy of ureteral catheter internal drainage during the primarysuture of laparoscopic choledocholithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis,and compare its advantages and disadvantages with those of the conventional primary suture.Methods A total of 53 cases with cholecystolithiasis complicated with choledocholithiasis treated in Sichuan Provincial People's Hospital from April of 2015 to May of 2017 were selected and divided randomly into the experiment group(n=26)and the control group(n=27).Both groups were treated with laparoscopic cholecystectomy and primary suture of common bile duct exploration,while the experiment group was treated additionally with ureteral catheter internal drainage.Results All the 53 patients underwent the operation successfully.There were 1 case with incision infection and 1 case with pancreatitis in the experiment group and the total complication rate was 7.69%,while there were 1 case with biliary leakage,1 case with abdominal cavity infection and 1 case with pancreatitis,and the total complication rate was 11.11%.The postoperative hospitalization time and total hospitalization cost in the experiment group were significantly less than those in the control group(P<0.05).There were no significant differences between the two groups in the operation time,intraoperative blood loss,first postoperative exhaust time and related postoperative complications(P>0.05).Conclusion For the patients with cholecystolithiasis complicated with choledocholithiasis,the combined treatment with laparoscopic cholecystectomy,primary suture of common bile duct exploration and ureteral catheter internal drainage is safe and effective since it expands the indication of the primary suture of common bile duct,shortens the postoperative hospitalization time and reduces the cost of hospitalization without increasing the incidence of postoperative complications.

关 键 词：胆囊结石 胆总管结石 输尿管导管内引流 胆总管一期缝合 

分 类 号：R657.4[医药卫生—外科学]