腹腔镜胆总管探查术后一期缝合与置T管引流的比较

Comparison between primary closure and T-tube drainage of common bile duct after laparoscopic exploration

目的探讨腹腔镜胆总管探查一期缝合术的安全性。方法回顾性分析笔者两院2002年6月—2007年1月因胆总管结石行腹腔镜胆总管探查术113例的临床资料,比较胆总管一期缝合61例(缝合组)与T管引流52例(引流组)的临床效果。结果手术时间和腹腔引流时间在两组间的差异无显著性(P>0.05),缝合组的术后住院时间和补液量少于引流组(P<0.05)。缝合组在术后胆漏(4/61),结石残留(2/61)和结石复发(5/61)等并发症方面与引流组的(分别为2/52,3/52,4/52)比较差别无统计学意义(P>0.05)。引流组拔T管后引起胆汁性腹膜炎2例。两组均未发生术后胆管狭窄。结论腹腔镜胆总管探查后一期缝合是一种安全的手术方法。

Objective To investigate the safety of primary closure of common bile duct after laparoscopic exploration. Methods We retrospectively analyzed the clinical results of laparoscopic common bile duct exploration （LCBDE） for common bile duct stone performed on 113 cases between June 2002 and January 2007. Of which, 61 cases had primary closure of common bile duct （closure group） , while 52 cases had T-tube drainage of common bile duct （ drainage group ） . Results There was no significant difference in terms of operation time and abdominal drainage time between the two groups （ P 〉 0.05 ）. Postoperative hospital stay was shorter and fluid replacement was less in closure group than that in drainage group. Postoperative bile leakage was seen in 4 cases （4/61）in closure group, and 2 cases （2/52） in drainage group （ P 〉0.05 ） . Retained bile duct stones were seen in 2 ca^es （ 2/61 ） in closure group, and 3 cases （ 3/52 ） in drainage group （P 〉0.05 ）. Bile duct recurrent stones was seen in 5 cases （5/61）in closure group, while 4 cases （4/52） in drainage group （P 〉 0.05 ）. Bile peritonitis was seen in 2 cases after T tube removal. There were no cases of postoperative extrahepatic duct stenosis in the two groups. Conclusions Primary closure of common bile duct after LCBDE for common bile duct stones is safe.