腹腔镜下胆管一期缝合与T管引流对肝外胆管结石的临床疗效比较

Comparison on the Clinical Effect of Primary Duct Closure and T-tube Drainage under Laparoscopy on Extrahepatic Bile Duct Stones

目的比较腹腔镜下胆管一期缝合与T管引流两种处理方法对肝外胆管结石的临床疗效。方法将2009年8月至2013年8月在涉县医院行腹腔镜胆管切开取石术的90例肝外胆管结石患者采用随机数字表法随机分为观察组和对照组,各45例。取石完毕后观察组采用可吸收缝合线将切开的胆总管前壁连续缝合,对照组放置T管引流。比较两组患者手术时间、肛门排气时间、腹腔引流时间、住院时间、术后恢复至正常生活时间及并发症发生情况,并对两组患者术后6个月、术后1年生活质量进行评价。结果观察组手术时间、肛门排气时间、腹腔引流时间、住院时间、恢复至正常生活时间均显著少于对照组[(96±27)min比(122±41)min,(32±6)h比(42±7)h,(3.8±0.8)d比(4.5±0.7)d,(5.8±1.2)d比(7.1±0.8)d,(15.6±2.7)d比(31.5±8.7)d,均P<0.01]。两组术后消化病生存质量指数心理情绪、生理功能、主观症状以及总分评分均随时间增长在6个月、1年逐渐增高,两组各项不同时点间差异均有统计学意义(均P<0.05)。观察组术后并发症发生率为6.7%(4/45),对照组为15.6%(7/45),观察组并发症发生率显著低于对照组(P<0.05)。结论胆管一期缝合术总体疗效优于放置T管引流,且安全性更高;在严格掌握适应证的情况下,可优先考虑用于肝外胆管结石的微创治疗。

Objective To compare the clinical efficacies of primary duct closure and T-tube drainage under laparoscopy in treating extrahepatic bile duct stones.Methods A total of 90 patients with extrahepatic bile duct stones received laparoscopic bile duct lithotomy in She County Hospital from Aug .2009 to Aug. 2013 were randomly divided into the observation group（45 cases） and control group（45 cases） .After lithot-omy,the front walls of common bile duct incision in patients of the observation group were continuously sutured by using absorbable suture,while patients in the control group were placed T tube for drainage.Oper-ation time,anus exhaust time,abdominal drainage time, hospitalization time,as well as time of postoperative recovery to normal life and the incidences of complications of the two groups were compared,and quality of life of the two groups was evaluated 6 months and 1 year after operation.Results The operation time,anus exhaust time,peritoneal drainage time,hospitalization time,and time of recovery to normal life in observation group were significantly less than those of the control group[（96 ±27） min vs （122 ±41） min,（32 ±6） h vs （42 ±7） h,（3.8 ±0.8） d vs （4.5 ±0.7） d,（5.8 ±1.2） d vs （7.1 ±0.8） d,（15.6 ±2.7） d vs （31.5 ±8.7） d,all P〈0.01].Gastrointestinal quality of life index （GLQI） scores including psychological mood scores,physiological functions scores,subjective symptoms scores and total GLQI scores in two groups were gradually increased 6 months and 1 year after operation,the difference of each score at the same time point was statistically significant（P 〈0.05）.The incidence of postoperative complications in observation group was 6.7%（4/45）,while that of the control group was 15.6%（7/45）,the complication rate of the observation group was significantly lower than that of the control group（P〈0.05）.Conclusion The overall effect of primary duct closure is superior to that of T-tube drainage, and primary duct closure has higher safety,while indications are strictly controlled,it can be prioritized for minimally invasive treatment of extra-hepatic bile duct stones.