腹腔镜胆总管探查内支架引流及T管引流治疗肝外胆管结石的临床研究

Laparoscopic Cholecystectomy and Common Bile Duct Exploration with Biliary Stent Drainage or T Tube Drainage in Treatment of Extrahepatic Bile Duct Stones

目的探讨腹腔镜胆囊切除胆总管探查(LCBDE)+内支架引流或T管引流术治疗胆囊结石合并肝外胆管结石的疗效及临床价值。方法回顾性分析湖北医药学院附属人民医院2008年6月至2013年6月期间由同一术者实施LCBDE的68例胆囊结石合并肝外胆管结石患者的临床资料。68例中行LCBDE+内支架引流(支架引流组)22例,LCBDE+T管引流术(T管引流组)46例。结果 2组均顺利完成手术。支架引流组在肛门排气时间、腹腔引流时间、术后住院时间及住院费用方面均短于或少于T管引流组(P<0.05),而手术时间、术后胆红素水平及术后并发症发生率2组间的差异均无统计学意义(P>0.05)。结论行LCBDE+内支架引流和T管引流术各有其适应证。对适宜患者,LCBDE+内支架引流术治疗肝外胆管结石患者的疗效优于LCBDE+T管引流术。

Objective To investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration （LCBDE） with biliary stent drainage or T tube drainage. Methods The clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage （stent drainage group）, 46 patients were treated with LCBDE and T tube drainage （T tube drainage group）. Results The operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group （P〈0.05）. There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups （P〉0. 05）. Conclusions The stent drainage and T tube drainage after LCBDE has its own indications, Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo- scopic common bile duct exploration and T tube drainage.