改良贯穿缝合T管在腹腔镜胆道手术中的应用价值

Application value of modified through-suture T-tube in laparoscopic biliary tract surgery

目的探讨改良贯穿缝合T管在腹腔镜胆道手术中的应用价值。方法采用回顾性描述性研究方法。收集2022年1—12月吉林大学中日联谊医院收治的15例胆囊结石合并胆总管结石行腹腔镜胆道手术患者的临床资料;男8例,女7例;年龄为(49±14)岁。15例患者中,8例行腹腔镜胆囊切除+胆总管探查取石+常规T管引流术,设为常规组;7例行腹腔镜胆囊切除+胆总管探查取石+改良贯穿缝合T管引流术,设为改良组。观察指标:(1)术中和术后情况。(2)随访情况。正态分布的计量资料以■±s表示,组间比较采用t检验。计数资料以绝对数表示,组间比较采用Fisher确切概率法。结果(1)术中和术后情况。两组患者均顺利完成手术,术后生命体征平稳,无不适症状。常规组和改良组患者术后住院时间比较,差异无统计学意义(P>0.05)。(2)随访情况。两组患者均完成术后30 d门诊随访。常规组和改良组患者窦道壁厚度比较,差异有统计学意义(P<0.05)。常规组8例患者中,2例术后30 d行T管造影检查确认无结石残留后拔除T管,其中1例发生胆瘘,重新留置引流管;6例延长T管留置时间至术后6周,行T管造影检查确认无结石残留后拔除T管,均无胆瘘发生。改良组7例患者中,2例术后30 d行T管造影检查发现胆总管结石残留,拔除T管后行经皮胆道镜取石,窦道壁形成良好,取石顺利;5例行T管造影检查确认无结石残留后拔除T管,均无胆瘘发生。结论改良贯穿缝合T管可用于腹腔镜胆道手术。

Objective To investigate the application value of modified through-suture T-tube in laparoscopic biliary tract surgery.Methods The retrospective and descriptive study was constructed.The clinical data of 15 patients with cholecystolithiasis and choledocholithiasis who underwent laparoscopic biliary tract surgery in China-Japan Friendship Hospital of Jilin University from January to December 2022 were collected.There were 8 males and 7 females,aged(49±14)years.Of 15 patients,8 cases undergoing laparoscopic cholecystectomy+common bile duct exploration and lithotomy+conventional T-tube drainage were set as conventional group and 7 cases undergoing laparoscopic cholecystectomy+common bile duct exploration and lithotomy+modified through-suture T-tube drainage were set as modified group.Observation indicators:(1)intraoperative and postoperative conditions;(2)follow-up.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was conducted using the t test.Count data were described as absolute numbers,and comparison between groups was conducted using Fisher exact probability.Results(1)Intraoperative and postoperative conditions.Both groups of patients successfully completed the operation,with postoperative vital signs as stable,and no discomfort symptoms.There was no significant difference in duration of postoperative hospital stay between the coventional group and the modified group(P>0.05).(2)Follow-up.Both groups of patients completed 30 days of postoperative outpatient follow-up.There was a significant difference in the sinus wall thickness between the coventional group and the modified group(P<0.05).Among the 8 patients in the conventional group,T tube was removed in the first 2 cases of patients after T tube angiography 30 days after operation,and biliary fistula occurred in 1 of them and the drainage tube was re-indurated.For the other 6 cases,the time of T tube retention was extended to 6 weeks after surgery.After T tube angiography,the T tube was removed and no biliary fistula occurred.Among the 7 patients in the modified group,2 cases with residual choledocholithiasis were found by T tube angiography 30 days after operation.After removal of T tube,percutaneous choledochoscopy was performed,in which the sinus wall was well formed and stone removal was smooth.The other 5 patients were confirmed no residual calculi by T-tube angiography,and then the T-tube was removed,with no biliary fistula.Conclusion Modified through-suture T-tube can be used in laparoscopic biliary tract surgery.