腹腔镜下C管胆道引流术临床观察

Clinical study on laparoscopic C tube drainage on patients with extrahepatic choledocholithiasis

目的探讨腹腔镜下C管引流治疗肝外胆管结石临床效果。方法回顾性分析2013年5月至2014年5月咸阳市第一人民医院肝胆外科85例肝外胆管结石患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定，接受3个月以上随访，按手术方式将患者资料根据引流方式不同分为C管引流组（A组）35例和T管引流组（B组）50例。A组：男16例，女19例，年龄（51．3±5．2）岁，BMI（20．47±4．51）kg／m^2；B组：男22例，女28例，年龄（50．4±5．6）岁，BMI（21．51±3．96）kg／m^2。分析比较两组患者术中出血量、手术时间、腹腔引流时间、肛门排气时间、术后住院时间、住院费用、胆汁瘘、术后恢复正常生活时间、残余结石及胆总管狭窄有无等情况。结果85例手术均获得成功。两组无一例失访，A组平均随访时间分别为（3．7～13．7）个月和（3．6～13．4）个月。两组各出现一例胆瘘，经保守治疗后痊愈出院。两组均无残余结石和胆管狭窄发生。A组与B组术中出血量无统计学差异[（48±14）ml掷（47±18）ml，P〉0．05）]；A组与B组平均手术时间分别为（110±8）min与（131±9）min，A组与B组引流管留置时间分别为（3．1±0．9）d与（4．1±0．8）d，A组与B组肛门排气时间分别为（39．4±10．2）h与（51．8±9．5）h，A组与B组术后住院时间分别为（5．2±0．8）d与（9．2±1．1）d，A组与B组住院费用分别为（8110±725）元与（11135±978）元，A组与B组术后恢复正常生活时间分别为（14．6±3．5）d与（32．6±4．5）d，差异有统计学意义（P〈0．05）。结论腹腔镜下c管胆道引流术是治疗肝外胆管结石的安全有效手术方式之一，值得进一步推广。

Objective To evaluate the effect of laparoscopic C tube drainage on patients with extrahepatic choledocholithiasis. Methods From May 2013 to May 2014, Clinical data of 85 patients with extrahepatic cholangiolithiasis admitted in Department of Hepatobiliary Surgery of The Frst People＇s Hospital of Xianyang City were retrospectively studied. The informed consents of all patients were obtained and the ethical committee approval was received. All patients were followed up for more than 3 months. The patients were divided into two groups ： the C tube drainage group （ A group, 35 cases） and the T tube drainage group （B group, 50 cases）. There were 16 males and 19 females in the A group with age ranging from 46.1 to 56.5 years old, the average of BMI was （ 20.47 _＋ 4.51 ） kg/m2. There were 22 males and 28 females in the B group with age ranging from 44.8 to 56.0 years old, the average of BMI was （21.51 ±3.96） kg/m2. The intraoperative bleeding, surgical duration, postoperative length of hospital stay and curative period between two groups were compared by test. The incidence of bile leakage and bile duct stricturewere compared. Results 85 cases surgeries were completed successfully. None of the patients was lost to being followed up. Average follow-up time of group A and group B was 3.7-13.7 months and 3.6-13.4 months, respectively. A case of biliary fistula in the two groups recovered after adequate drainage treatment. The two groups had no residual calculi and bile duct stricture. The average operation time, the intraoperative bleeding, surgical duration, the indwelling time of drainage tube, The anus exhaust time, postoperative length of hospital stay and hospitalization cost in group A were （110 ±8） min, （48 ±14） ml, （3.1 ±0.9） d, （39.4 ±10.2） h, （5.2±0. 8） d and （8110 ±725） yuan, respectively. The average operation time, the intraoperative bleeding, surgical duration, the indwelling time of drainage tube, The anus exhaust time, postoperative length of hospital stay and hospitalization cost in group A were （131 ±9） min, （47 ±18） ml, （4. 1 ±0.8） d, （51. 8 ±9.5） h, （9. 2 ±1. 1） d and （11 135 ±978） yuan, respectively. Conclusion Laparoscopic C tube drainage on treatment patients with extrahepatie eholedocholithiasis was one of the safe and effective operation method.