胆总管切开探查术后胆管一期缝合与T管引流治疗结果比较

Clinic Study of the Effect of Primary Closure Compared with T-tube Drainage following Choledochotomy for Biliary Lithiasis

目的 :探讨胆总管切开探查术后胆管一期缝合的可行性及临床应用价值。方法 :10 3例胆总管结石患者按照胆管探查术后处理方法分成胆管一期缝合组 (19例 )和T管引流组 (84例 ) ,比较两组治疗结果。结果 :与T管引流组相比 ,一期缝合组在术后胆汁引流量、带管时间、术后住院时间、术后近期并发症方面具有极显著差异 (P <0 .0 1) ,在术中失血量、手术时间、手术死亡率方面无显著差异 (P >0 .0 5 )。结论 :胆总管探查术后胆管一期缝合不延长手术时间 ,不增加手术死亡率 ,可缩短术后住院时间 ,减少胆汁丧失量 ,避免因放置T管引起的各种并发症 。

Objective: To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi. Methods: 103 patients with the evidence of stones in the common bile duct underwent choledochotomy.Among them,19 received primary closure of the common bile duct and 84 T-tube drainage.Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. Results: The intraoperative blood lose,operation time and operative modality are similar in two groups(P>0.05).After surgery,the average hospital stay,the volume of bile drainage and the time with tube was 9.3 days,235.5ml and 6.8 days in primary closure group respectively,vs 16.8 days, 547.8ml and 28.6 days in T-tube group(P<0.01).The complication rate was 21.43% in T-tube group,while 5.26% in primary closure group(P<0.01). Conclusion:Primary closure of the common bile duct after choledochotomy is safe and effective in selected patients with common bile duct calculi.