腹腔镜胆总管探查取石一期缝合与T管引流的临床对比研究

Clinically comparative study of primary duct closure versus T-tube drainage in laparoscopic common bile duct exploration

目的:探讨腹腔镜胆总管切开取石一期缝合与T管引流术治疗胆总管结石的临床疗效及相关问题。方法:前瞻性研究2013年6月至2014年6月收治的70例胆总管结石患者的临床资料。经术前筛选、术中具体情况综合判断将患者分为一期缝合组(n=34)与T管引流组(n=36),对比分析两组患者的术前资料、手术时间、术后住院时间、术后排气时间、住院费用、术后胆道相关并发症等情况。结果:患者均行择期手术,两组术前资料、手术时间、术后排气时间、术后胆道并发症差异无统计学意义(P>0.05)。一期缝合组住院时间、住院费用少于T管引流组,差异有统计学意义(P<0.05)。结论:腹腔镜胆总管探查取石一期缝合术治疗胆总管结石安全、有效,避免了T管相关弊端,缩短了住院时间,减少了住院费用,值得推广应用。

Objective： To discuss the clinical effects and corresponding questions of choledochus primary suture and T-tube drainage after laparoscopic exploration of common bile duct in the treatment of choledocholithiasis. Methods： The clinical data of 70 patients who suffered from common bile duct stones between Jun. 2013 and Jun. 2014 were prospectively studied. In accordance with preoperative filtering and intraoperative special conditions,patients were divided into two groups,34 patients underwent choledochus primary suture and 36 patients received T-tube drainage. Preoperative clinical data,the operation time,the length of postoperative hospital stay,postoperative anal exhaust time,postoperative hospitalization expenses,cholangio corresponding complications were comparatively analyzed between the two groups. Results： All operations were elective surgery. There were no significant differences in the preoperative data,the operative time,postoperative anal exhaust time,the incidences of postoperative cholangio corresponding complications between the two groups（ P〉0. 05）. Compared with the T-tube drainage group,the length of postoperative hospital stay and hospitalization costs in suture group were significantly fewer（ P〈0. 05）. Conclusions： Laparoscopic common bile duct primary suture is a safe and effective method to treat common bile duct stones. It not only avoids the potential disadvantages of T-tube but also reduces the length of postoperative hospital stay and hospitalization expenses. This procedure deserves surgeons to generalize and apply.