肝外胆管结石腹腔镜联合胆道镜切开取石一期缝合的临床疗效研究

Clinical study of primary suture of extrahepatic bile duct stones by laparoscopic hepatectomy

目的探讨运用腹腔镜对肝外胆管结石切开取石后一期缝合的临床效果。方法将63例肝外胆管结石患者根据手术方式不同分为两组。观察组(一期缝合组)27例,对照组(置T管引流组)36例,对比两组患者手术时间、出血量、术后腹腔引流管拔除时间、胆瘘及并发症发生情况。结果两组患者腹腔镜下手术均获成功。两组患者术中出血量比较,差异无统计学意义(P>0.05);观察组患者手术时间、术后拔出腹腔引流管时间和住院时间均短于对照组(P<0.01),住院费用少于对照组(P<0.01)。结论通过评估肝外胆管结石患者的病情,采用腹腔镜联合胆道镜行胆总管切开取石后一期缝合,免置T管治疗,临床效果显著,安全性高,值得推广应用。

Objective To explore the clinical effect of laparoscopy of common extrahepatic bile duct stones after primary suture. Methods Sixty-three cases of patients with extrahepatic bile duct stones,according to the actual operation procedure,which were divided into experimental group（ primary suture group,27 cases） and control group（ T tube drainage group,36 examples）. The operation time,bleeding volume,the time of drainage tube and the incidence of biliary fistula and biliary fistula between the two groups were compared. Results Laparoscopic operation of two groups of patients were operated successfully,the bleeding volume of two groups was not statistically different（ P〈0.05）. Operation time of the experimental group was shorter than that of the control group,postoperative abdominal drainage tube time of the experimental group was shorter than that of the control group,Length of stay of the experimental group was shorter than that of the control group（ P〈0.01）. The total cost of the experimental group was lower than that of the control group（ P〈0.01）. Conclusion By evaluating the condition of patients with extrahepatic bile duct stones,strictly abide by the principle of operation,through the joint choledochoscope line of common bile duct incision laparoscopic lithotomy,after a primary suture,free T tube treatment,the clinical curative effect is safe,effective and worth application.