双镜联合胆总管探查取石术后胆总管一期缝合与T管引流疗效对比

Comparison of clinical efficacy between primary suture and T-tube drainage after laparoscopic and choledochoscopic common bile duct exploration

目的探讨腹腔镜联合胆道镜下胆总管探查取石术后胆总管一期缝合与T管引流的疗效和安全性比较。方法回顾总结常州市武进人民医院2014年6月至2016年12月100例成功实施双镜联合胆总管探查取石术患者的临床资料,其中胆总管一期缝合组30例,T管引流组70例,比较两组手术时间、术中出血量、腹腔引流时间、术后住院时间和并发症发生率等指标。结果两组患者手术顺利,无中转开腹,无手术死亡病例。一期缝合组术后发生胆漏1例,T管引流组术后胆漏2例(χ~2=0.016,P=0.898),两组手术时间[(135.7±42.2)min vs(148.6±50.1)min,P=0.225]和术中出血量[(47.0±57.6)mL vs(56.6±49.1)mL,P=0.408]差异无统计学意义;但一期缝合组腹腔引流时间及术后住院时间明显少于T管引流组,差异有统计学意义(P<0.01)。结论掌握手术适应证前提下,双镜联合胆总管探查取石胆总管一期缝合方法安全可行,体现了微创的理念,值得临床推广应用。

objective To compare the clinical efficacy between primary suture and T-tube drainage after laparoscopic and choledochoscopy common bile duct exploration,and to explore the feasibility and indication.Methods Retrospective analysis were performed for the clinical data of 100 cases undergone laparoscopic and choledochoscopy common bile duct exploration from Jun.2014 to Dec.2016.Patients were divided into primary suture group（n=30） and T tube drainage group（n=70）.Operative duration,intra-operative blood loss,drainage time,hospital stay after surgery and rate of postoperative complications between two groups were compared.Results All operations were successfully completed and no transfer to laparotomy and post-operative death were occurred.In the primary suture group,one patient experienced bile leakage,and two patients experienced bile leakage in T-tube drainage group（χ~2=0.016,P=0.898）.There were no statistical differences in the operative duration [（135.7±42.2） min vs（148.6±50.1） min,P=0.225] and intra-operative blood loss [（47.0±57.6） mL vs（56.6±49.1） mL,P=0.408].However,in primary suture group,the drainage time and hospital stay after surgery were shorter than those in T-tube drainage group with statistical significance（P〈0.01）.Conclusion With appropriate indications,primary suture after laparoscopic and choledochoscopy common bile duct exploration is safe and mini-invasive,which is worth application in clinic.