腹腔镜胆总管探查一期缝合与T管引流治疗胆总管结石的疗效比较

Comparison of the effect of primary suture and T tube drainage of laparoscopic common bile duct exploration in the treatment of patients with choledocholithiasis

目的 比较腹腔镜胆总管探查一期缝合术与T管引流治疗胆总管结石的疗效.方法 选取肝外胆管结石患者57例,其中25例设为观察组,采用腹腔镜胆总管探查一期缝合术;32例设为对照组,采用T管引流术.记录并比较两组患者手术时间、术后胃肠道恢复时间、腹腔引流时间、术后住院时间、住院费用及术后并发症的发生情况（胆漏与胆总管残石）.结果 患者均顺利完成手术,无中转开腹患者.观察组术后胃肠道恢复时间、术后住院时间分别为（1.7±0.5）d、（5.3±1.6）d,显著短于对照组的（2.1±0.3）d、（9.2±1.9）d（t=11.73、6.27,均P＜0.05）;观察组住院费用为（6 873±2 541）元,显著高于对照组的（6 079±2 492）元（t=5.93,P＜0.05）.观察组手术时间、腹腔引流时间分别为（86.3±19.6）min、（89.7±21.6）h,均短于对照组的（97.1±21.1）min、（98.2±22.7）h,但差异均无统计学意义（均P＞0.05）.观察组术后发生胆漏4例,胆总管残石1例,并发症发生率为20.00％,对照组术后发生胆漏2例,胆总管残石3例,胆汁性腹膜炎2例,并发症发生率为21.87％,两组并发症发生率差异无统计学意义（x2 =0.15,P＞0.05）.术后随访1～2年,观察组结石复发率为12.00％,对照组结石复发率15.60％,两组差异无统计学意义（x2=0.36,P＞0.05）.结论 腹腔镜胆总管切开取石一期缝合胆总管壁治疗胆管结石具有创伤小、疼痛轻、康复快、住院时间短等优点,值得临床应用推广.

Objective To compare the effect of primary suture and T tube drainage of laparoscopic common bile duct exploration（LCBDE） in the treatment of patients with choledocholithiasis.Methods A total of 57 patients with calculus of extrahepatic bile duct were selected and they were randomly divided into observation group（n =25,treated by LCBDE） and control group（n =32,treated by T tube drainage）.The operation time,postoperative recovery time of gastrointestinal tract,abdominal drainage time,postoperative hospital stay,hospitalization expenses and postoperative complications were recorded and compared between the two groups.Results All the patients were successfully completed surgery,and no patients had open surgery.The recovery time and postoperative hospital stay of the observation group were （1.7 ± 0.5） d,（5.3 ± 1.6） d,respectively,which were significantly shorter than （2.1 ± 0.3） d,（9.2 ± 1.9） d of the control group （t =11.73,6.27,all P ＜ 0.05）,and the cost of hospitalization of the observation group was （6873 ± 2 541）RMB,which was significantly higher than （6 079 ± 2 492）RMB of the control group （t =5.93,P ＜ 0.05）.The operation time and drainage time of the observation group were （86.3 ± 19.6） min,（89.7 ± 21.6） h,respectively,which were shorter than （97.1 ± 21.1） min,（98.2 ± 22.7） h of the control group,but the differences were not statistically significant（all P ＞ 0.05）.There were 4 cases of postoperative bile leakage and 1 case of common bile duct residual stones in the observation group,and the incidence rate of complications was 20.00％.There were 2 cases of bile leakage,3 cases of common bile duct residual stones and 2 cases of biliary peritonitis in the control group,and the incidence rate of complications was 21.87％.There was no statistically significant difference in the incidence rate of complications between the two groups （x2 =0.15,P ＞0.05）.All the patients were followed up for 1 to 2 years,the recurrence rate of stones in the observation group was 12.00％,which was similar to 15.60％ in the control group （x2 =0.36,P ＞ 0.05）.Conclusion Primary suture of laparoscopic common bile duct exploration has the advantages such as less trauma,less pain,faster recovery and shorter hospital stay in the treatment of patients with choledocholithiasis,which is worthy of clinical application and popularization.