124例腹腔镜下胆总管切开取石一期缝合与T管引流的临床差异比较  

Comparison between primary suture and T tube drainage in 124 cases of laparoscopic choledocholithotomy

作　　者：翟敏 秦安成[1] 钱易 黄博[1] 陆轶杰 乔志明[1] 蒋新卫[1] 吴建武[1] Zhai Min;Qin Ancheng;Qian Yi;Huang Bo;Lu Yijie;Qiao Zhimin;Jiang Xinwei;Wu Jianwu(Department of General Surgery,Suzhou Municipal Hospital,Nanjing Medical University,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普外科,苏州215000

出　　处：《中国医师进修杂志》2022年第7期609-612,共4页Chinese Journal of Postgraduates of Medicine

基　　金：苏州市临床重点项目(LCX201711);苏州市医学重点学科(SZXK201808)。

摘　　要：目的探讨腹腔镜下胆总管切开取石一期缝合与T管引流的临床差异。方法回顾性研究2018年12月至2020年2月南京医科大学附属苏州医院诊治的124例腹腔镜下胆总管切开取石患者的临床资料。依据不同手术方式分为一期缝合组(71例)和T管引流组(53例),比较两组患者相关治疗指标的差异。结果两组患者性别构成、高血压、糖尿病、术前天冬氨酸氨基转移酶、术前丙氨酸氨基转移酶、术前总胆红素、术前胆总管直径、术后住院天数、住院总费用、术后排气时间、术后胆漏等治疗指标比较差异无统计学意义(P>0.05);一期缝合组与T管引流组比较,术前单发胆总管结石比例多(33例比15例)、手术时间短[(100.14±38.90)min比(140.45±54.17)min]、术中出血少[(35.70±30.17)ml比(49.53±34.58)ml]、术后Winslow孔引流管拔除时间晚[(7.15±2.61)d比(5.45±3.35)d],差异有统计学意义(P<0.05)。结论在严格掌控一期缝合手术适应证,由能娴熟操作腹腔镜及胆道镜的普外科医生操作的条件下,腹腔镜下胆总管切开取石一期缝合疗效好于T管引流,具有较高的临床应用价值。Objective To investigate the clinical difference between primary suture and T tube drainage in laparoscopic choledocholithotomy.Methods The clinical data of 124 patients treated by laparoscopic choledocholithotomy in Suzhou Municipal Hospital from December 2018 to February 2020 were retrospectively studied.The patients were divided into the primary suture group(71 cases)and the T tube drainage group(53 cases)according to the different surgical methods,and the differences in the relevant treatment indicators were compared between the two groups.Results There were no statistically significant differences between the two groups in gender,hypertension,diabetes mellitus,preoperative aspartate aminotransferase,preoperative alanine aminotransferase,preoperative total bilirubin,preoperative common bile duct diameter,postoperative length of stay,total cost of hospitalization,postoperative exhaust time,or postoperative biliary leakage,et al.Compared with the T tube drainage group,the primary suture group had more single choledocholithiasis before operation(33 cases vs.15 cases),shorter operation time:(100.14±38.90)h vs.(140.45±54.17)h,less intraoperative bleeding:(35.70±30.17)ml vs.(49.53±34.58)ml,and later extraction time of Winslow hole drainage tube after operation:(7.15±2.61)d vs.(5.45±3.35)d,and the differences were statistically significant(P<0.05).Conclusions Under the condition of strictly controlling the indications of primary suture and being operated by general surgeons who can skillfully operate laparoscope and choledochoscope,laparoscopic choledocholithotomy for primary suture has better curative effect than T tube drainage,and has higher clinical application value.

关 键 词：胆总管结石病 腹腔镜 T管引流 一期缝合 

分 类 号：R657.42[医药卫生—外科学]