腹腔镜胆总管切开取石术中一期缝合与T管引流的应用比较

Comparison on application of primary suture and T-tube drainage during laparoscopic common bile duct exploration

目的比较腹腔镜胆总管切开取石术(laparoscopic common bile duct exploration,LCBDE)中一期缝合与T管引流在胆总管结石患者中的应用效果。方法回顾性分析2017年2月至2019年2月上海健康医学院附属周浦医院收治的82例胆总管结石患者,并根据手术方案将其分为A组(39例)和B组(43例),A组采用LCBDE术中一期缝合治疗,B组采用LCBDE术中T管引流治疗;统计两组的手术时间、术中出血量、拔管时间、胃肠道恢复时间以及住院总时间;比较两组治疗前、后的血清白细胞介素-1β(IL-1β)、C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)等炎性因子水平变化情况及两组术后总并发症发生率。结果 A组的手术时间、胃肠道恢复时间以及住院时间均短于B组,差异具有统计学意义(P<0.05),两组患者的术中出血量、拔管时间比较,差异无统计学意义(P>0.05);A组治疗后,血清IL-1β、CRP和TNF-α水平均低于B组,差异具有统计学意义(P<0.05);A组的总并发症发生率(7.69%)与B组(13.95%)比较,差异无统计学意义(P>0.05)。结论 LCBDE术中一期缝合相比T管引流能够显著缩短手术时间、胃肠道恢复时间以及住院时间,改善患者炎性因子表达水平。

Objective To compare application effect of primary suture and T-tube drainage during laparoscopic common bile duct exploration(LCBDE).Methods A retrospective analysis was performed on 82 patients with common bile duct stones who admitted to Zhoupu Hospital from Feb.2017 to Feb.2019.According to different surgical procedures,patients were divided into group A(39 cases)and group B(43 cases).Group A were treated with primary suture in LCBDE,while group B were treated with T-tube drainage in LCBDE.The operation time,intraoperative blood loss,extubation time,gastrointestinal recovery time and total hospitalization time in both groups were statistically analyzed.The changes in levels of serum interleukin-1β(IL-1β),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)before and after treatment were compared between the two groups.The total incidence of postoperative complications in both groups was statistically analyzed.Results The operation time,gastrointestinal recovery time and hospitalization time in group A were all shorter than those in group B(P<0.05).There was no statistical difference in intraoperative blood loss or extubation time between the two groups(P>0.05).After treatment,levels of serum IL-1β,CRP and TNF-αin group A were lower than those in group B(P<0.05).There was no significant difference in total incidence of complications between group A and group B(7.69%vs 13.95%,P>0.05).Conclusion Compared with T-tube drainage,primary suture in LCBDE can more significantly shorten operation time,gastrointestinal recovery time and hospitalization time of CBDS patients and improve the expression levels of inflammatory factors in patients with common bile duct stones.