腹腔镜下胆总管探查术放置内引流管与放置T管的临床疗效分析  

Clinical efficacy of intra-biliary drainage versus T-tube drainage following laparoscopic common bile duct exploration

作　　者：杜开放 王希春 魏磊 赵昌志 冯众一 郎桂玲 Du Kaifang;Wang Xichun;Wei Lei;Zhao Changzhi;Feng Zhongyi;Lang Guiling(Department of Hepatobiliary Surgery,Dalian Friendship Hospital of Dalian Medical University,Institute of Hepatobiliary Surgery of Dalian,Dalian 116001,China)

机构地区：[1]大连医科大学附属大连市友谊医院肝胆外科,大连市肝胆外科研究所,大连116001

出　　处：《中华肝胆外科杂志》2023年第10期732-736,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：大连市友谊医院科研启动经费项目(FH2022026)。

摘　　要：目的评估腹腔镜胆总管探查取石术(LCBDE)放置内引流管治疗胆总管结石的临床疗效,并与放置T管比较。方法回顾性分析2018年1月至2022年10月大连医科大学附属大连市友谊医院收治的胆总管结石患者的临床资料。根据手术方式不同,将患者分为两组,LCBDE放置内引流管患者为内引流管组,放置T管患者为T管组。通过倾向性评分匹配两组患者基线资料,共纳入50例胆总管结石患者,其中男性23例,女性27例,年龄(61.3±16.2)岁,每组25例。比较两组手术时间、术中出血量、术后住院时间、腹腔引流管拔出时间、胆汁引流量和术后并发症的差异。结果与T管组相比,内引流管组的手术时间[(155.0±36.5)min比(194.4±55.8)min]、术后住院时间[8.0(7.0,8.0)d比11.0(8.0,13.0)d]、腹腔引流管拔出时间[5.0(4.0,6.0)d比6.0(5.0,8.0)d]均缩短,胆汁引流量减少[0 ml比431.4(344.7,484.3)ml],差异均具有统计学意义(均P<0.05)。两组患者术后均无胆漏发生,两组患者术中出血量以及术后结石残留、结石复发、胆管狭窄发生比例差异均无统计学意义(均P>0.05)。结论 LCBDE放置内引流管是安全有效的术式,在手术时间、术后住院时间、腹腔引流管拔出时间、胆汁引流量方面优于LCBDE放置T管。Objective To evaluate the clinical efficacy of intra-biliary drainage versus T-tube drainage following laparoscopic common bile duct exploration(LCBDE)for choledocholithiasis.Methods The clinical data of 50 patients undergoing LCBDE for choledocholithiasis in Dalian Friendship Hospital of Dalian Medical University from January 2018 to October 2022 were retrospectively analyzed,including 23 males and 27 females,aged(61.3±16.2)years old.Patients were divided into the intra-biliary drainage group and T-tube drainage group.Propensity score matching was used to match the baseline data of the two groups at a 1∶1 ratio.The operation time,intraoperative blood loss,postoperative hospital stay,abdominal drainage tube indwelling time,postoperative bile drainage volume and postoperative complications were compared between the groups.Results Compared with the T-tube group,the operative time[(155.0±36.5)min vs.(194.4±55.8)min],length of postoperative hospital stay[8.0(7.0,8.0)d vs.11.0(8.0,13.0)d],and abdominal drainage tube indwelling time[5.0(4.0,6.0)d vs.6.0(5.0,8.0)d]were all shorter in the intra-biliary drainage tube group(all P<0.05).The postoperative bile drainage volume was reduced[0 ml vs.431.4(344.7,484.3)ml].No postoperative bile leakage occurred in either group.The intraoperative blood loss,proportion of postoperative residual stone,stone recurrence and biliary stricture were comparable between the two groups(all P>0.05).Conclusion Intra-biliary tube drainage following LCBDE could be safe and effective for choledocholithiasis.Compared to the classic procedure of T-tube drainage,it may be superior in the operation time,postoperative hospital stay,abdominal drainage tube indwelling time,postoperative bile drainage volume.

关 键 词：胆总管结石病 腹腔镜胆总管探查取石 胆道内引流管 T管引流 

分 类 号：R657.4[医药卫生—外科学]