腹腔镜胆总管探查术一期缝合与T管引流手术治疗胆囊结石继发胆总管结石的疗效观察  

Observation on the clinical efficacy of primary suture and T tube drainage following laparoscopic common bile duct exploration for the treatment of gallstones complicated with common bile duct stones

作　　者：刘滋伟[1] 马振宇[1] 商伟岩 LIU Ziwei;MA Zhenyu;SHANG Weiyan(Department of General Surgery,Beijing Jingmei Group General Hospital,Beijing 102300,China)

机构地区：[1]北京京煤集团总医院普外科,北京102300

出　　处：《中国现代医生》2020年第35期47-50,共4页China Modern Doctor

摘　　要：目的探讨腹腔镜胆总管探查术(LCBDE)一期缝合与T管引流手术治疗胆囊结石继发胆总管结石(GCBDS)的疗效,为临床治疗提供参考依据。方法回顾性分析2015年4月~2019年4月于我院接受手术治疗的80例GCBDS患者临床资料。按照手术方式不同分为A组与B组,每组各40例,两组均接受LCBDE治疗,A组术中采用一期缝合,B组术中使用T管引流。比较两组围术期情况、结石清除率、胃肠道生活质量指数(GIQLI)及术后并发症。结果两组术中出血量情况比较,差异无统计学意义(P>0.05),A组手术时间、肛门排气时间、住院时间均明显短于B组,住院费用明显比B组少,差异有统计学意义(P<0.05);两组结石清除率比较,差异无统计学意义(P>0.05);两组术前、术后3个月、6个月时GIQLI评分比较,差异无统计学意义(P>0.05),A组术后1个月时GIQLI评分明显高于B组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论LCBDE一期缝合与T管引流手术治疗GCBDS的疗效相似,均可有效清除结石,但一期缝合操作更简单、术后恢复快,可早期改善患者生活质量,值得应用推广。Objective To explore the clinical efficacy of primary suture and T tube drainage following laparoscopic common bile duct exploration(LCBDE)for the treatment of gallstones complicated with common bile duct stones(GCBDS),so as to provide reference for clinical treatment.Methods The clinical data of 80 GCBDS patients who received surgical treatment in our hospital from April 2015 to April 2019 were retrospectively analyzed.According to different surgical methods,the patients were divided into group A and group B,with 40 patients in each group.Both groups received LCBDE treatment.Group A was treated with primary suture during operation,and group B was treated with T tube drainage during operation.Perioperative conditions,stone clearance rate,gastrointestinal quality of life index(GIQLI)and postoperative complications were compared between the two groups.Results There was no significant difference in intraoperative blood loss between two groups(P>0.05).The operative time,anal exhaust time and hospitalization time in group A were significantly shorter than those in group B,and the hospitalization expenses was significantly lower than that in group B,with statistically significant differences(P<0.05).There was no significant difference in stone clearance rate between the two groups(P>0.05).There was no significant difference in GIQLI scores between the two groups at preoperative,postoperative 3 months and 6 months(P>0.05).GIQLI score in group A was significantly higher than that in group B 1 month after operation(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion The primary suture and T tube drainage following LCBDE have a similar efficacy in the treatment of GCBDS,and both can effectively remove stones.However,the primary suture is simpler with faster postoperative recovery,which can improve the quality of life of patients in the early stage,and it is worthy of application and promotion.

关 键 词：胆囊结石继发胆总管结石 腹腔镜胆总管探查术 一期缝合 T管引流 生活质量 并发症 

分 类 号：R657.4[医药卫生—外科学]