单猪尾胆道支架在腹腔镜胆总管探查并一期缝合中的应用  

Applications of single pig-tail biliary stents placement via choledochoscopy in laparoscopic common bile duct exploration and primary duct closure

作　　者：李劲[1] 徐盟 王兵[1] 田锐 LIJin;XU Meng;WANG Bing(Department of BiliaryPancreatic Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,武汉430030

出　　处：《临床外科杂志》2023年第4期364-367,共4页Journal of Clinical Surgery

摘　　要：目的对比腹腔镜胆总管探查后,经胆道镜直视下顺行置入单猪尾胆道支架并行胆总管一期缝合术与T管引流术的疗效及安全性。方法2019年6月~2022年6月我院行腹腔镜下胆总管探查术的病人98例。按手术方式不同分为胆道支架组(40例)及T管引流组(58例)。比较两组病人术前一般情况、术中情况、术后恢复及并发症等指标。结果胆道支架组手术耗时、胆总管操作耗时、出血量、术后VAS疼痛指数、Caprini评分均短于(少于)T管引流组,差异有统计学意义(P<0.05)。两组无术后死亡及再次手术。两组术后首日总胆红素、γ-谷氨酰转肽酶、镇痛药使用次数比较差异无统计学意义(P>0.05),胆道支架组术后首日血清白蛋白、肛门排气时间、抗生素使用时间、白细胞恢复正常时间、腹腔引流管拔除时间、术后住院时间、胆道引流时间及总费用显著优于T管引流组,差异有统计学意义(P<0.05)。两组术后并发症发生率分别为5.0%和6.9%,两组比较差异无统计学意义(P>0.05)。结论经胆道镜顺行置入单猪尾胆道支架并行胆总管一期缝合安全性好,术后恢复快,不长期带管。Objective To compare the efficacy and safety of single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure with traditional T-tube drainage after laparoscopic common bile duct exploration.Method A total of 98 cases who underwent laparoscopic common bile duct exploration in our hospital from June 2019 to June 2022 were included retrospectively.They were divided into bile duct stents group(BD-stent group,40 cases)and the T-tube drainage group(TTD group,58 cases)according to the surgery type.The general conditions,intraoperative indicators,postoperative recovery and complications in two groups were statistically compared.Result In terms of surgery,the BD-stent group had significantly less surgery time,bile-duct-operation time,bleeding volume,postoperative VAS index and Caprini score than the TTD group(P<0.05).Both groups had no mortality or reoperation.There were no significant differences in first-day serum total bilirubin,γ-GT and total analgesia usage between two groups(P>0.05).But the first-day serum albumin,anal ventilation time,antibiotic usage,leukocyte recovery days,drain-tube removal days,bile duct drainage days,postoperative hospital stay and total costs in BD-stent group were significantly better than those in TTD group(P<0.05).As for postoperative complications,the rate in BD-stent group and TTD group were respectively 5.0%and 6.9%,without significant differences(P>0.05).Conclusion Single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure has unique advantages in safety and rapid recovery.It avoids long-term drainage.

关 键 词：胆管结石 胆总管探查 胆管一期缝合 胆管支架置入 胆道镜取石 

分 类 号：R657.4[医药卫生—外科学]