LC+LCBDE胆总管一期缝合与T管引流治疗胆囊胆总管结石的随机对照研究

Randomized controlled study of primary closure versus T-tube drainage after aparoscopic cholecystectomy combined with laparoscopic common bile duct exploration application in cholecystolithiasis and choledocholithiasis

目的对比腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查术(LCBDE)术中胆总管一期缝合与T管引流在胆囊合并胆总管结石治疗中的疗效差异,分析术式优越性。方法选取上海交通大学医学院附属仁济医院胆胰外科2014年7月至2016年3月收治的177例胆囊伴胆总管结石患者,采用随机数表法将患者分为一期缝合组89例与T管引流组88例,比较两组患者的手术有效性、安全性、经济性、患者的生活质量指数及手术耐受性。结果一期缝合组与T管引流组手术成功率均为95.5%,差异无统计学意义(P>0.05);一期缝合组与T管引流组并发症发生率分别为12.4%和11.4%,差异亦无统计学意义(P>0.05),但一期缝合组在手术时间、住院费用、术后住院时间和术后GIQLI生存质量方面均优于T管引流组,且差异均有统计学意义(P<0.05)。结论 LC+LCBDE术中一期缝合胆总管与T管引流在胆囊伴胆总管结石的治疗中的手术成功率及并发症发生率相近,证实一期缝合术式安全、有效,且具有操作简单、创伤小、康复快、费用低、术后生存质量高等优点,可推广使用。

Objective To compare the curative effects of primary closure and T-tube drainage after laparoscopic cholecystectomy（LC） combined with laparoscopic common bile duct exploration（LCBDE） treated on cholecystolithiasis and choledocholithiasis.Methods A total of 177 patients with cholecystolithiasis and choledocholithiasis,admitted to Department of Biliary and Pancreatic Surgery of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between July 2014 and March 2016,were selected and divided into the primary closure group（n=88） and Ttube drainage group（n=89） according to random number table method.The efficiency,safety,economy of the operation,postoperative gastrointestinal quality of life questionnaire,as well as the surgical tolerance between the two groups were compared.Results There was no significant difference in the surgery success rate between the primary closure group and T-tube drainage group（both 95.5%,P〈0.05）.The incidence rate of complications was 12.4% in the primary closure group versus 11.4% in the T-tube drainage group（P〈0.05）.However,the primary closure group were significantly higher than the T-tube drainage group in terms of operative time,hospitalization expenses,postoperative hospitalization time,postoperative Gastrointestinal Quality of Life Index（GIQLI）（P〈0.05）.Conclusion Primary closure after LC＋LCBDE has similar success rate and complication incidence rate with T-tube drainage after LC＋LCBDE in the treatment of cholecystolithiasis and choledocholithiasis,but primary closure after LC＋LCBDE has simplicity of operation,less minimal invasive,rapid recovery,less cost and higher postoperative survival quality,which may be used as the first choice.