胆总管一期缝合和T管引流的临床研究

Clinical study on primary suture of common bile duct and T-tube drainage

目的探讨胆总管一期缝合和T管早期间断夹闭的临床意义。方法研究101例胆总管探查手术病例的治疗，按随机数字表法分为三组，其中33例行胆总管一期缝合（A组），33例行T管早期间断夹闭（B组），35例行T管引流14d常规夹闭（C组），对比三组治疗效果。结果A、B组患者术后肠功能恢复时间、补液量、住院时间分别为（47．63±12．42）h、（2．75±0．27）L／d、（8．0±0．3）d和（57．63±14．15）h、（2．97±0．49）L／d、（10．0±0．4）d，均明显低于C组的（98．27±30．35）h、（3．63±0．38）L／d、（19．0±1．1）d，差异有统计学意义（P＜0．05）；A组患者术后肠功能恢复时间优于B组，差异有统计学意义（P＜0．05）。三组丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ谷氨酰转移酶、体温、白细胞、总胆红素、胆瘘、胆总管残石、胆总管狭窄比较差异无统计学意义（P＞0．05）。结论胆总管一期缝合和T管早期间断夹闭能促进肠功能恢复，避免电解质代谢紊乱，减少补液量、电解质及营养支持，减少住院时间及费用，是对传统胆总管探查手术方法的改进和完善，是安全、高效的，有临床应用意义。

Objective To explore the clinical significance of primary suture of common bile duct and early intermittented clamping of T-tube. Methods One hundred and one cases underwent bile duct surgery were divided into three group by random digits table, in which 33 cases were performed with primary suture of common bile duct （group A）, 33 cases were applied of early intermittented clamping of T-tube （group B）,the other 35 cases were clamped T-tube as in routine measures （group C）. The efficacy was compared between three groups. Results The postoperative intestinal function recovery time, fluid support, hospitalization time in group A and group B was （47.63 ± 12.42） h, （2.75±0.27） L/d, （8.0±0.3） d and （57.63 ± 14.15） h, （2.97±0.49） L/d, （10.0±0.4） d,which was significantly decreased compared with those in group C [ （98.27 ± 30.35 ） h, （3.63 ± 0.38 ） L/d, （ 19.0 ± 1.1 ） d ] （P 〈 0.05 ）. Postoperative intestinal function recovery in group A was significantly increased compared with those in group B （P 〈 0.05）. Alanine aminotransferase, aspartate aminotransferase, Gamma-glutamine transferase, body temperature, white blood cell count,total bilirubin,postoperative biliary fistula,common bile duct residual stones,stenosis of the common bile duct had no significant differences among three groups （P 〉 0.05）. Conclusions Primary suture of common bile duct and early intermittented clamping of T-tube can accelerate recovery of intestinal function ,avoid electrolyte disturbance, reducing fluids, electrolytes and nutrition support, reducing the length of stay and costs, it has changed the traditional way of surgical treatment of bile duct, and is safe, efficient, also has significance of clinical application.