两种方法治疗胆总管结石的效果比较

Comparison of curative effect of two methods in treatment of common bile duct calculus

目的比较胆总管探查术后行一期缝合术与T型管引流术治疗胆总管结石的效果和安全性。方法选择2010年8月～2013年8月期间笔者收治的胆总管结石患者共112例,其中56例在胆总管探查术后行一期缝合术,为观察组;另外56例在胆总管探查后行T型管引流术,为对照组。比较两组术中、术后的相关情况及随访结果。结果两种手术术中所需时间、术中出血量以及术后引流量无统计学差异,观察组术后补液量、术后排气时间及住院总时间均少于对照组（P〈0.05）;两组术后5 d各项生化指标均较术前明显改善（P〈0.05）,且两组间比较各项生化指标均无统计学差异（P〉0.05）。随访结果显示,两组并发症的发生率无统计学差异（P〉0.05）,两组均未发现结石残留或胆管狭窄情况。结论胆道探查术术后在条件适宜的前提下,采用一期缝合术能获得与T型管引流术相当的治疗效果,且更有利于患者的术后康复,安全性好。但其普适性仍差于T型管引流术,对于相对禁忌的患者应谨慎选择。

Objective To compare the curative effect and safety of primary suture and T-tube drainage in treatment of common bile duct calculus after laparoscopic common bile duct exploration （LCBDE）. Methods Total 112 patients with common bile duct calculus to receive treatment in our department from Aug. 2010 to Aug. 2013 were selected, among which 56 ones to receive primary suture constituted the observation group, and the other 56 ones to receive T-tube drainage after LCBDE constituted the control group. The patients ＂conditions during and after the operation, and the follow-up results were compared between two groups. Results The operation time, amount of bleeding,and postoperative amount of drainage had no statistically significant differences between the patients in the two groups, and the postoperative amount of fluid, exhaust time and hospitalization time of the observation group were lower than those of the control group（P 〈0.05） ;the postoperative 5 d biochemical indexes in beth groups were improved than the preoperative ones（P 〈0.05） ,and the biochemical indexes between the two group had no statistically significant differences （ P 〉 0.05 ）. The follow-up results showed that the incidences of complications between the two groups had no statistical difference （P 〉 0.05）, and there was no residual bile duct calculus or strictures in the two groups. Condusion Under appropriate conditions after LCBDE,primary suture has equivalent curative effect to T- tube drainage, is more conducive to the postoperative rehabilitation of patients, and has higher safety. However, it has worse universality than T-tube drainage,so the patients with relative contraindications should select the proper method carefully.