同期三镜联合偏弯双头尾翼胆道支架预防胆总管探查一期缝合术后并发症的临床应用  

Clinical application of simultaneous triple mirrors combined with deviated double-headed tail biliary stent to prevent complications after primary suture of common bile duct exploration

作　　者：李慧华[1] 吕日新 林树浩 Li Huihua;Lu Rixin;Lin Shuhao(Department of thyroid hepatobiliary surgery,Huizhou third people's hospital,Huizhou,Guangdong,516002,China)

机构地区：[1]惠州市第三人民医院甲状腺肝胆外科,广东惠州516002

出　　处：《齐齐哈尔医学院学报》2023年第2期143-147,共5页Journal of Qiqihar Medical University

基　　金：惠州市科技计划项目(2020Y229)。

摘　　要：目的探究同期三镜联合偏弯双头尾翼胆道支架预防胆总管探查一期缝合术后并发症中的应用价值。方法选择2018年1月—2021年1月于本院诊断为胆总管结石并实施手术治疗的86例患者作为研究对象,将其按照选择手术方式的不同分为观察组和对照组两组,每组各43例。对照组患者实施腹腔镜下胆总管取石一期缝合或留置T管引出腹腔外手术,观察组实施腹腔镜下胆总管取石一期缝合,术中留置胆道支架,对比两组患者手术时间、术中出血量、术后胃肠功能恢复时间、术后住院时间、住院费用差异,比较两组患者治疗疗效以及肝功变化。结果观察组患者手术时间、术中出血量及术后胃肠功能恢复时间低于对照组相应指标,但组间相比,差异无统计学意义(P>0.05);观察组患者术后住院时间短于对照组,住院费用少于对照组相应指标,差异具有统计学意义(P<0.05);两组主要并发症为胆瘘、结石复发、狭窄、出血,其中观察组胆瘘、结石复发、狭窄、出血分别为2.33%、0.00%、0.00%、0.00%,均分别低于对照组的4.65%、2.33%、2.33%、4.65%、其中观察组术后各类并发症总发生率为2.33%,低于对照组的13.95%,差异具有统计学意义(P<0.05)。术前两组TBIL、ALT、ALP对比,差异无统计学意义(P>0.05);术后48 h观察组患者TBIL、ALT、ALP分别为(51.76±9.87)μmol/L、(36.87±4.32)U/L、(130.12±34.28)U/L,对照组为(51.85±10.21)μmol/L、(36.12±3.29)U/L、(131.72±30.53)U/L,均较治疗前出现明显的下降,差异具有统计学意义(P<0.05),术后48 h两组患者TBIL、ALT、ALP水平比较,差异无统计学意义(P>0.05)。结论胆总管探查一期缝合术后采用术后留置偏弯双头尾翼胆道支架可以显著加快患者围术期康复进程,有助于降低术后各类并发症的发生率,还可以降低患者医疗费用,值得临床推广应用。Objective To explore the application value of the simultaneous triple mirror combined with deviated double-headed tail biliary stent in the prevention of complications after the primary suture of the common bile duct exploration.Methods 86 patients who were diagnosis as choledocholithiasis and underwent surgery in our hospital from January 2018 to January 2021 were enrolled as study subjects.They were divided into observation group and control group according to the difference in the choice of surgical methods,43 patients in each group.The control group received laparoscopic common bile duct stone removal with one-stage suture or the indwelling T tube leads to extra-abdominal surgery.The observation group performed laparoscopic common bile duct stone removal with primary suture and indwelling biliary stent during the operation.The operation time,intraoperative blood loss,postoperative gastrointestinal function recovery time,postoperative hospitalization duration and hospitalization cost were compared between the two groups.The therapeutic effect and liver function changes of the two groups were compare.Results The operation time,intraoperative bleeding and postoperative recovery time of gastrointestinal function in the observation group were lower than those in the control group,however,there were no significant difference between the two groups(P>0.05).The postoperative hospitalization time of the observation group was shorter than that of the control group,and the hospitalization cost was less than the corresponding indexes of the control group,the difference was statistically significant(P<0.05).The main complications of the two groups were bile fistula,stone recurrence,stenosis and bleeding.The incidence of bile fistula,stone recurrence,stenosis and bleeding in the observation group were 2.33%,0.00%,0.00% and 0.00% respectively,which were lower than 4.65%,2.33%,2.33% and 4.65% in the control group.The total incidence of postoperative complications in the observation group was 2.33%and that in the control grou

关 键 词：偏弯双头尾翼胆道支架 胆总管结石手术 一期缝合术 术后并发症 

分 类 号：R657[医药卫生—外科学]