腹腔镜胆道探查术后胆管一期缝合与T管引流的疗效比较

Primary duct closure versus T-tube drainage following laparoscopic choledochotomy

目的 比较分析腹腔镜胆道探查术后胆管一期缝合与T管引流两种方法治疗胆囊结石继发胆总管结石患者的疗效。方法 依据 6项病例筛选标准 ,将 2 0 0 0年 1月至 2 0 0 3年 2月 5 5例因胆囊结石继发胆总管结石行腹腔镜胆管切开取石治疗的患者 ,随机分为胆管一期缝合组和T管引流组 ,比较观察两组的手术和住院时间、输液量、住院费用、术后恢复情况及手术并发症等。结果胆管一期缝合组 2 7例患者 ,T管引流组 2 8例患者 ,一期缝合组较T管引流组术后住院时间更短 ,肛门排气和恢复正常工作更快 ,输液量和住院费用更少。一期缝合组手术并发症 3例 (11 1% ) ,T管引流组手术并发症 8例 (2 8 6 % ) ,其中需再次外科手术治疗的严重并发症 3例 (10 7% ) ,严重并发症均由放置T管造成。两组患者随访结果差异无显著性意义。结论 腹腔镜胆管切开取石术后胆管一期缝合避免了放置T管引起的一系列弊端 ,体现出微创外科技术的优越性 ,治疗适合的胆囊结石继发胆总管结石患者是安全可行的。

Objective To evaluate the effects of primary duct closure and T-tube drainage in laparoscopy choledochotomy to treat the common bile duct stones. MethodsThe enrollment of the patients was in accordance with 6 criteria. 55 patients with cholecystolithiasis and secondary common bile duct stones from January 2000 to February 2003 were treated with laparoscopic choledochotomy. The patients were randomly divided into two groups: primary duct closure group and T-tube drainage group. Their all data were recorded and studied prospectively,and patients were followed up after discharge. ResultsThere were 27 patients and 28 patients in primary duct closure group and T-tube drainage group respectively. The operation time and the results of following up between the two groups had no significant difference. Compared with T-tube drainage group,primary duct closure group had less the total quantity of postoperative transfusion and hospital costs,shorter postoperative hospital stay. The incidence of postoperative complications in primary duct closure group was 11.1%(3/27),and all of them were biliary complications. The incidence of postoperative complications in T-tube drainage group was 28.6%(8/28),and seven of them were biliary complications. The incidence of severe complications that neened reoperations was 10.7%(93/28),and all of them were caused by T-tubes. There was no mortality in two groups. ConclusionsThe primary duct closure in laparoscopic choledochotomy can avoid the deficiency of T-tube drainage,and it is feasible and safe and lower complications in treating the common bile duct stones,so we advocate it in appropriate cases.