腹腔镜胆总管切开取石术后内置管引流与T管引流临床研究

THE CLINICAL STUDY OF INTERNAL-TUBE DRAINAGE AND T-TUBE DRAINAGE AFTER LAPAROSCOPIC CHOLEDOCHOLITHOTOMY

目的 :比较分析腹腔镜胆总管切开取石术后内置管引流与T管引流两种方法对患者康复的影响。方法 :回顾性总结分析 1999年以来行腹腔镜胆总管切开取石术后内置管引流的 2 6例患者临床疗效 ,并与同期行T管引流的 31例患者进行了比较。结果 :内置管引流组术后无胆汁丢失 ,较T管引流组痛苦小、胃肠功能恢复快。两组比较 ,手术时间无明显差异 ,术后开始进食时间分别为 13.8± 3.4,35 .5± 6 .8h ,(P <0 .0 5 ) ,恢复肠蠕动时间为 30 .5± 5 .6 ,43.8± 7.4h ,(P <0 .0 5 ) ,抗生素平均使用天数 3.5± 0 .6 ,6 .4± 1.1d ,(P <0 .0 5 ) ,术后输液量 45 5 0± 5 84,135 0 0± 12 5 0ml,(P <0 .0 1) ,术后平均住院日 4.6± 1.7,9.6± 2 .4d ,(P <0 .0 1) ,平均住院费用 815 0± 910 ,5 0 0± 12 70元 (P <0 .0 5 ) ,恢复日常工作时间 12 .8± 2 .5 ,2 7.4± 6 .9d ,(P <0 .0 5 )。结论 :腹腔境胆总管探查、内置管引流术后胆总管一期缝合避免了T管引起的并发症 ,大大减轻了患者的痛苦 ,缩短了输液时间和住院时间 ,减少了抗生素的用量 ,值得推广应用。

Objective:To analyse the influence of internal-tube drainage and T-tube drainage on the recovery of patients who underwent laparoscopic choledocholithotomy.Methods:The clinical curative effect of 26 patients who underwent laparoscopic choledocholithotomy with internal-tube drainage from 1999 were reviewed retrospectively,and was compared with 31 patients who underwent laparoscopic choledocholithotomy with T-tube drainage.Results:Compared with the T-tube group, internal-tube drainage had no bile lost and less pain. The operation time between the two groups had no significant differences, the time to begin taking food after operation was 13.8 ±3. 4 and 35. 5±6. 8 (hours, P <0. 05) , to restore gastri-intestinal movement was 30.5±5.6 and 43.8± 7.4(hours, P <0.05), administrated antibiotics days after operation was 3.5±0.6 and 6.4±1.1 (days, P <0.05) , the total quantity of postoperative transfusion was 4550±584 and 13500±1250 (ml, P <0.01 ), the postoperative stay was 4.6±1.7 and 9.6±2.4(days, P <0.01), the hospital expense was 8180±910 and 11500±1270(Yuan, P <0.05),the time to restart routine work was 12.8 ±2.5 and 27.4±6.9 (days, P <0.05) .Conclusion:The internal-tube drainage and primary closure of common bile duct after laparoscopic choledocholithotomy can eliminate the complications of T-tubes,greatly alleviate the patient's suffering,shorten the transfusion time and in-hospital time,reduce the dosage of antibiotics.We advocate it in appropriate cases.