胆总管单边缝合法在腹腔镜胆总管切开取石T管引流术中的临床疗效分析  

Clinical efficacy analysis of unilateral suture fixation of common bile duct in laparoscopic choledocholithotomy with T-tube drainage

作　　者：刘威 沈根海 王刚 高泉根 LIU Wei;SHEN Genhai;WANG Gang(Department of Minimally Invasive General Surgery,Suzhou Ninth People's Hospital,Suzhou 215200,China)

机构地区：[1]苏州市第九人民医院微创普外科,江苏苏州215200

出　　处：《腹腔镜外科杂志》2024年第3期217-221,共5页Journal of Laparoscopic Surgery

基　　金：苏州市科技发展计划(SYSD2018041)。

摘　　要：目的:探讨腹腔镜胆总管切开取石T管引流术中应用胆总管单边缝合法的临床疗效、特点与优势。方法:回顾分析2018年1月至2022年6月为160例患者行腹腔镜胆总管切开取石术的临床资料,按T管缝合固定方法分为对照组与观察组,每组80例。对照组置入T管后行胆总管双边缝合,观察组行胆总管单边缝合。对比分析两组T管置入缝合时间、术中出血量、术后住院时间及术后胆道出血、胆漏等并发症发生率。结果:两组均顺利完成腹腔镜手术,术后未发生胆道出血、T管脱出、术区积液及感染,观察组T管置入缝合时间短于对照组(P<0.05),术中出血量少于对照组(P<0.05),两组术后住院时间、术后胆漏发生率差异无统计学意义(P>0.05)。两组术后均发生胆漏,其中对照组4例(5%),观察组2例(2.5%),经充分引流后治愈,均未发生严重并发症。随访期间两组均无相关并发症发生。结论:腹腔镜胆总管切开取石T管引流术中应用胆总管单边缝合法具有操作简单、流程稳定、安全可靠、疗效良好的特点,值得临床推广。Objective:To explore the curative effect,features and advantages of unilateral suture fixation of common bile duct in laparoscopic choledocholithotomy with T-tube drainage.Methods:The clinical data of 160 patients who underwent laparoscopic choledocholithotomy with T-tube drainage from Jan.2018 to Jun.2022 were retrospectively analyzed.The patients were divided into control group and observation group according to the suture fixation method of common bile duct,with 80 cases in each group.The control group underwent T-tube insertion and bilateral suture fixation of common bile duct,while the observation group underwent T-tube insertion and unilateral suture fixation of common bile duct.The T-tube insertion and suture operation time,intraoperative blood loss,postoperative hospital stay and incidence of postoperative complications such as biliary bleeding and bile leakage of the two groups were compared.Results:All laparoscopic surgeries were successfully completed,and there was no postoperative biliary bleeding,T-tube prolapse,postoperative hydrops and infection.Compared with control group,the observation group had shorter T-tube insertion and suture operation time and fewer intraoperative blood loss(P<0.05).There were no significant differences in postoperative hospital stay and the incidence of postoperative bile leakage between the two groups(P>0.05).Bile leakage was the mainly postoperative complication of the two groups,there were 4 cases(5%)in the control group and 2 cases(2.5%)in the observation group.But the amount of bile leakage was not large,and it disappeared after adequate drainage for about a week,without serious complications.Patients in the two groups were followed up,and no related complications occurred.Conclusions:The unilateral suture fixation of common bile duct in laparoscopic choledocholithotomy with T-tube drainage has the characteristics of simple operation,stable process,safety and reliability,and good therapeutic effect,and is worthy of clinical application.

关 键 词：胆总管结石病 胆道探查术 腹腔镜检查 T管引流 

分 类 号：R657.4[医药卫生—外科学]