腹腔镜胆总管切开探查一期缝合治疗肝外胆管结石对患者术后恢复的影响

The Influence of Laparoscopic Choledochotomy with Primary Closure for Treating Extrahepatic Duct Stones on Patient's Recovery

目的探讨腹腔镜下胆总管切开探查一期缝合治疗肝外胆管结石对患者术后恢复的影响。方法随机将70例胆囊合并胆总管结石患者分为两组,分别用腹腔镜下胆总管切开探查一期缝合与传统开腹胆总管切开探查 T 管引流治疗,比较两组患者术后肛门恢复排气时间、首次下床活动时间、术后住院时间、并发症、输液时间上的区别。结果腹腔镜下一期缝合与开腹 T管引流组术后均无出血、胆漏。腹腔镜下一期缝合组术后肛门排气恢复平均需要36h,首次下床活动平均需要12h,术后平均住院时间3d,平均输液时间2d;而开腹 T 管引流组的术后肛门排气恢复平均需要70h,首次下床活动平均需要46h,术后平均住院时间7d,平均输液时间5d,两组差异有显著意义(P<0.01)。同时开腹 T 管引流组有1例发生切口感染,有1例发生残留结石,有1例在术后第21d 拔管后发生胆漏。结论腹腔镜下胆总管切开探查一期缝合能全面促进患者恢复,缩短住院时间,避免 T管所致的各种可能并发症。

Objective To discuss the influence of laparoscopic choledochotomy with primary closure for treating extruhepatic duct stones on patient＇s recovery. Methods 70 patients with common bile duct stones were divided into 2 groups randomly, one was treated as laparoscopic choledochotomy with primary closure, the other was treated as open choledochotomy with T tube drainage respectively, the differences between two groups on timing of postoperative passing gas, time of ambulation, hospital stay, complication, duration of fluid replacement were compared. Results No bleeding or bile leakage occured in both groups. In group of laparoseopic choledeehotomy , passing gas was 36 hours at postoperative. Ambulation was started 12 hours postoperatively, mean hospital stay was 3 days, mean duration of postoperative fluid replacement were 2 days. In the group of open choledochotomy , pass gas was 70 hours after postoperatively. Ambulation was at 46 hours postoperatively, mean of hospital stay was 7 days, mean duration of post - operative fluid replacement was 5 days. Significance difference existed in two groups （ P 〈0.01 ）, In group of open choledochotomy, wound infection occurred in one case, stone was retained in one case, bile leakage after removal of T tube happened in one case. Conclusions Laparoscopic choledochotomy with primary closure for treating extrahepatic duct stones will promote patient postoperative recovery, shorten hospital stay, and avoid potential complications related to T tubes.