胆总管结石术后一期缝合与T管引流的疗效对比及复发因素分析  

Comparison of the efficacy of primary suture and T-tube drainage in patients with choledocholithiasis and analysis of influencing factors for postoperative recurrence

作　　者：黄博[1] 陈一帆 翟敏 秦安成[1] 陆轶杰 吴建武[1] 蒋新卫[1] 乔志明[1] Huang Bo;Chen Yifan;Zhai Min;Qin Ancheng;Lu Yijie;Wu Jianwu;Jiang Xinwei;Qiao Zhiming(Department of Hepatobiliary Surgery,Suzhou Municipal Hospital,Suzhou Hospital Affiliated to Nanjing Medical University,Jiangsu Suzhou 215000,China)

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院肝胆外科,江苏苏州215000

出　　处：《中国医刊》2021年第9期980-984,共5页Chinese Journal of Medicine

基　　金：苏州市临床重点项目(LCZX201711);苏州市医学重点学科(SZXK201808)。

摘　　要：目的比较分析胆总管结石行腹腔镜下胆囊切除(laparoscopic cholecystectomy,LC)+胆总管探查(laparoscopic common bile duct exploration,LCBDE)术后一期缝合与T管引流的临床疗效,并探讨其术后复发的影响因素。方法回顾性分析2014年1月至2019年6月在南京医科大学附属苏州医院行LC+LCBDE治疗的132例胆总管结石患者的临床资料,将其中50例行胆总管一期缝合的患者纳入观察组,82例行T管引流的患者纳入对照组,对比两组患者的围术期指标[术中出血量、手术时间、引流时间、住院时间、术后恢复饮食时间及术后24h的疼痛视觉模拟量表(visual analogue scale,VAS)评分]、术后并发症(胆漏、切口感染、结石残余、电解质紊乱)发生情况、胆总管结石复发情况,分析术后复发的影响因素。结果两组术中出血量和术后恢复饮食时间比较差异无显著性(P>0.05);与对照组比较,观察组手术时间及住院时间明显缩短,术后24h的VAS评分明显降低,但引流时间明显延长,差异均有显著性(P<0.05)。观察组与对照组术后总并发症发生率(分别为14.00%和17.28%)比较差异无显著性(P>0.05),但观察组胆漏发生率(8.00%)明显高于对照组(1.22%),胆总管结石复发率(2.00%)明显低于对照组(12.20%),差异有显著性(P<0.05)。单因素分析发现,胆总管结石术后复发与患者年龄、是否合并乳头旁憩室、胆总管结石数目、胆总管直径、结石最大直径、手术方式相关(P<0.05),多因素logistic回归分析发现,胆总管结石数目(≥2个)、结石最大直径(≥10mm)、乳头旁憩室形成、T管引流为胆总管结石术后复发的独立危险因素(OR=0.713、0.158、5.103、6.015,P<0.05)。结论胆总管结石行LC+LCBDE后一期缝合胆总管疗效满意,可改善患者围术期指标,减轻术后疼痛,降低术后复发率。Objective To explore the clinical effects of laparoscopic cholecystectomy(LC)and common bile duct exploration(LCBDE)in patients with choledocholithiasis and T-tube drainage,and to explore the factors affecting the recurrence of patients after surgery.Method To retrospectively analyze the data of 132 patients with common bile duct stones who underwent LC combined with LCBDE treatment in our hospital from January 2014 to June 2019.Among them,50 patients who underwent primary suture were included in the observation group,and 82 patients who underwent T tube drainage Cases were included in the control group.The perioperative indicators[intraoperative blood loss,operation time,drainage time,hospitalization time,postoperative recovery time to diet and 24h visual analogue score(VAS score)],postoperative complications(bile leakage,incision)Infection,residual stones,electrolyte imbalance),the recurrence of common bile duct stones after surgery and the influencing factors of the recurrence.Result The blood loss during the operation and the time to recover from eating and drinking after the operation were similar in the two groups(P>0.05).Compared with the control group,the operation time and hospital stay of the observation group were significantly shortened(P<0.05),the VAS score at 24 hours after operation was significantly reduced(P<0.05),but the drainage time was significantly increased(P<0.05).The incidence of postoperative complications in the observation group and the control group(14.00%vs 17.28%)was similar(P>0.05),the incidence of bile leakage in the observation group and the control group(8.00%vs 1.22%)and the recurrence of common bile duct stones after surgery The rate(2.00%vs 12.20%)is significantly different(P<0.05).Univariate analysis found that the postoperative recurrence of choledocholithiasis was related to the patient’s age,whether it was combined with nipple diverticulum,the number of choledocholithiasis,the diameter of the choledochus,the maximum diameter of the choledochus,and the operation method(P

关 键 词：胆总管结石 T管引流 术后复发 胆总管探查术 一期缝合 腹腔镜下胆囊切除术 

分 类 号：R657.42[医药卫生—外科学]