腹腔镜胆总管探查胆道一期缝合与“T”管引流的临床疗效分析

Comparison of clinical efficacy between primary suture and T-tube drainage after laparoscopic choledochotomy

目的探讨肝外胆管结石患者经腹腔镜胆总管切开探查取石行一期缝合与"T"管引流2种术式的临床疗效。方法回顾性分析2011年2月—2013年2月新疆医科大学第一附属医院肝脏腹腔镜外科50例肝外胆管结石患者行腹腔镜胆总管探查取石术的临床资料,分为两组:一期缝合组(primary suture,PS)21例,"T"管引流组(T-tube drainage,TD)29例,比较两组患者手术时间、术中出血量、住院费用、术后肛门排气时间、术后下床活动时间、术后补液量、术后带管时间、术后住院时间及术后并发症(胆漏、胆管狭窄、消化不良、腹腔感染、胆管炎、残余结石)发生情况。结果两组患者手术均成功,治愈后出院,无死亡病例。PS组术后出现2例胆漏、1例胆总管残余结石及2例术后消化不良,TD组术后出现3例胆漏、1例胆总管残余结石及3例术后消化不良,两组均无胆总管狭窄、胆管炎及腹腔感染者。PS组术后带管时间、术后肛门排气时间、住院费用、术后住院时间、术后下床活动时间、术后补液量少于TD组,两组差异有统计学意义(P<0.05);两组手术时间、术中出血量、术后并发症发生情况差异无统计学意义(P>0.05)。结论在严格掌握手术适应证的条件下,熟练的腹腔镜操作技术的支持下和腹腔镜胆总管探查取石一期缝合术较"T"管引流术效果更好,具有明显优势。

Objective To compare the clinical efficacy between primary suture and T-tube drainage after laparoscopic choledochotomy,and explore the clinical experience and feasibility.Methods The clinical data of 50 patients with extra-hepatic bile duct stones who underwent laparoscopic choledochotomy in Liver＆amp; Laparoscopic Surgery department from Feb.2011 to Feb.2013 were retrospectively analyzed.Among them,21 cases underwent primary suture （PS group）and 29 cases underwent T-tube drainage （TD group）.The parameters include operative time,intra-operative blood loss,hospitalization costs,normal gastrointestinal activity recovery time, postoperative ambulation time, postoperative fluid volume, drainage time,hospital stay after surgery and the incidence of postoperative complications （bile leakage, bile duct stricture,indigestion,abdominal infection,cholangitis,residual stones）.Results All patients were cured and discharged from hospital,and no post-operative death was occurred.In the primary closure group,two patients experienced bile leakage,one patient experienced residual stones and two patients ex-perienced indigestion,respectively,three patients experienced bile leakage,one patients experienced resid-ual stones and three patients experienced indigestion in the T-tube drainage group.In primary closure group,the hospitalization costs,normal gastrointestinal activity recovery time,postoperative ambulation＆amp;nbsp;time,postoperative fluid volume,drainage time and hospital stay after surgery were shorter than those in T-tube drainage group with statistical significance （P ＆lt;0.05）.There were no statistical differences in the operative time,intra-operative blood loss and the incidence of postoperative complications between two groups （P ＆gt; 0.05）.Conclusion With careful patient selection,the clinical effect of primary suture is better than T-tube drainage after laparoscopic choledochotomy.This surgical approach is the best choice for treatment of extra-hepatic bile duct stones.