腹腔镜联合胆道镜下胆总管切开探查取石术后一期缝合和T管引流术临床疗效分析

Clinical analysis of primary suture and T-tube drainage after laparoscopic choledocholithotomy

目的分析腹腔镜联合胆道镜下胆总管切开探查取石术后一期缝合术和T管引流术后的临床疗效,并探讨一期缝合术的手术适用性及安全性。方法回顾性分析我院2016年1月至2019年6月102例胆囊结石合并胆总管结石患者,其中一期缝合组44例,T管引流组58例。两组均实施双镜联合下胆总管切开探查取石,缝合组在双镜术式基础上采用一期缝合术,引流组在双镜术式基础上采用T管引流术,对比两组术后恢复情况、并发症发生率及手术前后炎性指标及肝功能指标。结果(1)术后恢复情况:一期缝合组术后首次排气时间早于T管引流组、住院时间短于T管引流组,一期缝合组总住院费用较T管引流组少(P<0.05);(2)两组并发症发生率比较无统计学差异(P>0.05);(3)手术前后炎性因子指标:术后1天两组WBC、N、CRP较术前升高,组间对比无统计学意义(P>0.05);术后3天两组WBC、N、CRP较术前、术后1天降低,组间对比无统计学意义(P>0.05);(4)手术前后肝功能指标:术前两组TBIL、ALT、AST、GGT、ALP比较,差异无统计学意义(P>0.05);术后1天两组TBIL、ALT、AST、GGT、ALP与术前相比有轻度增高,但组间无统计学意义(P>0.05);术后3天两组TBIL、ALT、AST、GGT、ALP低于术前、术后1d,组间对比无统计学意义(P>0.05)。结论在严格掌握适应症的情况下,双镜联合下胆总管切开探查取石术后一期缝合术是一种安全,有效的手术方式,较T管引流术能缩短住院时间,减少住院总费用,符合快速康复理念,有较高的经济应用价值,值得推广。

Objective To investigate the clinical effect between laparoscopic primary suture of common bile duct and T-tube drainage in the treatment of choledocholithiasis.Methods Retrospective analysis of 102 patients with gallstones and extrahepatic bile duct stones from January 2016 to June 2019 in our hospital,44 cases were in primary suture group and 58 cases were in T tube drainage group.Both cases were treated with laparoscopic common bile duct exploration.The postoperative recovery,complication rate and inflammatory indexes before and after surgery were compared between the two groups.White blood cell(WBC),neutrophi(N),C-reactive protein(CRP),liver function indicators[TBIL(total bilirubin),alanine aminotransferase(ALT),Tianmen Aspartate aminotransferase(AST),GGT and ALP].Results(1)Postoperative recovery:postoperative anal exhaust time and hospital stay were shorter in the suture group than in the drainage group(P<0.05);(2)There was no significant difference in the incidence of complications between the two groups(suture group and drainage group).(P>0.05);(3)Inflammatory factors before and after surgery:WBC、N and CRP were higher than those before operation,and there was no significant difference between the two groups(P>0.05).The levels of WBC、N and CRP were lower than those before and 1 days after operation.There was no significant difference between the groups(P>0.05).(4)Liver function indexes before and after operation:There was no significant difference in TBIL,ALT,AST,GGT and ALP between the two groups after operation(P>0.05).Conclusions Under the strict operation indication,laparoscopic primary suture of common bile duct is a safe and effective operation.Compared with T-tube drainage,it can shorten the hospitalization time and reduce the total cost of hospitalization.It is worthy of clinical application.