放置鼻胆管一期缝合胆总管与T管引流在腹腔镜及开腹胆囊切除、胆总管探查术中的效果比较

A comparative study on effect of common bile duct primary suture and T tube drainage in laparoscopic and open cholecystectomy and common bile duct exploration

目的比较一期缝合和T管引流在腹腔镜及开腹胆囊切除、胆总管探查术中的应用效果。方法选择胆总管结石患者124例为研究对象，所有患者均行胆囊切除＋胆总管探查术。按照患者住院顺序号，随机分为腹腔镜胆囊切除术＋胆总管探查＋鼻胆管引流一期缝合术组（腹缝组）、开腹胆囊切除术＋胆总管探查＋鼻胆管引流一期缝合术组（开缝组）、开腹胆囊切除术＋T管引流组（开引组）、腹腔镜探查＋T管引流组（腹引组），每组31例。比较四组胃肠功能恢复时间、胆汁引流量、拔管时间、住院时间、胆漏发生率和带管出院例数等。结果腹缝组胃肠功能恢复时间、胆汁引流量、拔管时间和住院时间均低于其他三组（P均〈0．05）。开缝组胆汁引流量、拔管时间和住院时间等指标均优于开引组（P均〈0．05）。四组术后胆漏发生率比较差异未见统计学意义（P〉0．05）。开缝组和腹缝组带管出院比例均低于开引组及腹引组（P均〈0．05）。结论相比T管引流，无论是开腹术还是腹腔镜应用鼻胆管一期缝合，均具有更好的效果。

Objective To compare the effect of common bile duct primary suture and T tube drainage in laparoscopic and open cholecystectomy and common bile duct exploration. Methods A total of 124 patients with choledocholithiasis were selected as the subjects. All patients underwent cholecystectomy ＋ common bile duct exploration. According to the order of hospitalization, patients were randomly divided into laparoscopic cholecystectomy ＋ common bile duct ＋ nasobiliary drainage and primary suture group （ ventral suture group）, open cholecystectomy ＋ common bile duct ＋ nasobiliary drainage and primary suture group （ open suture group） , open choleeystectomy ＋ T tube drainage group （ open drainage group） and laparoscopic eholeeystectomy ＋ T tube drainage group （ventral drainage group）, with 31 ca- ses in each group. The recovery time of gastrointestinal function, bile drainage volume, extubation time, hospital stay, rate of bile leakage and number of diseharged patients with tube were compared among the four groups. Results The recovery time of gastrointestinal function, bile drainage volume, extubation time and hospital stay in ventral suture group were significantly lower than those in the other 3 groups （P 〈 0. 05 ）. The bile drainage volume, extubation time and hospital stay were significantly better in open suture than those in open drainage group （ P 〈 0. 05 ）. The difference in ineidence of bile leakage after operation among the four groups was not statistically significant （ P 〉 0. 05 ）. However, the ratios of discharged patients with tube in open suture group and ventral suture group were significantly lower than those in open drainage group and ventral drainage group （P 〈 0. 05 ）. Conclusions Compared with the T tube drainage, common bile duct primary suture has better effect whether in the laparotomy or in the abdominal operation, and is worthy of clinical application.