胆总管一期缝合与T管引流两种术式在腹腔镜下胆总管切开胆道镜探查取石术后的效果比较  

Comparison of the effects of two surgical methods,primary closure of the common bile duct and T-tube drainage,in laparoscopic choledocholithotomy and choledochoscopy for stone extraction

作　　者：汤世军 陈志永 TANG Shijun;CHEN Zhiyong(Department of General Surgery,Maanshan People’s Hospital,Anhui 243000,China)

机构地区：[1]安徽省马鞍山市人民医院普外综合科,243000

出　　处：《临床外科杂志》2024年第4期392-395,共4页Journal of Clinical Surgery

摘　　要：目的 探索胆总管一期缝合与T管引流两种术式在腹腔镜下胆总管切开胆道镜探查取石术后应用的效果。方法 2019年1月~2023年5月期间收治行腹腔镜下胆总管切开胆道镜探查取石术的胆总管结石病人90例,采用随机数字表法分为两组,对照组45例,术后采用T管引流治疗;观察组45例,术后采用胆总管一期缝合治疗。比较两组治疗后手术相关指标、肝功能水平、术后并发症发生率,随访3个月,比较结石残留率。结果 两组术中出血量、术后排气时间、引流管拔除时间、术后并发症发生率、结石残留率比较,差异均无统计学意义(P>0.05),观察组取石时间、住院时间短于对照组,住院总费用元少于对照组,差异有统计学意义(P<0.05),术后1天,7天的TBil、ALT均低于对照组,差异有统计学意义(P<0.05)。结论 腹腔镜下胆总管切开胆道镜探查取石术后进行胆总管一期缝合,更能够缩短取石时间,减轻对肝损害,提高生存质量,加速病情康复。Objective To explore the effectiveness of two surgical methods,primary suture of the common bile duct and T-tube drainage,in laparoscopic choledocholithotomy and choledochoscopy for stone extraction.Method The prospectively selected 90 patients with laparoscopic lithotomy were treated from January 2019 to May 2023.They were divided into two groups.45 patients in the control group was treated with T tube drainage,and 45 patients in the observation group were treated with primary suture.Surgery-related indicators,IL-1βlevel,liver function level,and postoperative complication rate were compared.The residual stone rate was compared after 3 months.Results Intraoperative blood loss,postoperative exhaust time,drainage tube removal time,postoperative complication rate and stone residual rate were not statistically different between the two groups(P>0.05).The stone removal time and hospitalization time of the observation group were shorter than those of the control group,and the total hospitalization cost was less than that of the control group,with statistical significance(P<0.05).The TBil,ALT,TBil and ALT of 1 day after surgery were all lower than those of control group,and the difference was statistically significant(P<0.05).Conclusion One-stage suture of common bile duct after laparoscopic choledochotomy and choledochoscopy can shorten the time of lithotomy,reduce the liver damage,improve the quality of life and accelerate the recovery of the disease.

关 键 词：胆总管一期缝合 T管引流 腹腔镜 胆总管 胆道镜 取石术 

分 类 号：R657.4[医药卫生—外科学]