腹腔镜胆总管探查取石术中输尿管导管或T管胆总管引流的临床疗效

Clinical efficacy of common bile duct drainage with ureteral catheter or T-tube in laparoscopic common bile duct exploration and lithotomy

目的比较腹腔镜胆总管探查取石术中输尿管导管或T管胆总管引流的临床效果。方法胆囊结石合并胆总管结石老年患者156例,腹腔镜胆总管探查取石术中行一期缝合经胆囊管输尿管导管引流64例(细管组),采用T管引流92例(T管组)。比较两组的手术相关资料。结果156例均顺利完成手术,无术中中转开腹。与T管组比较,细管组手术时间[(103.1±27.0)min vs.(120.8±33.1)min]、术后引流管留置时间[(4.3±1.6)d vs.(5.3±2.1)d]和术后住院时间[(6.8±2.0)d vs.(8.4±2.3)d]均较短(P<0.01),住院费用也较少(P<0.01)。两组术中出血量、胆漏发生率和残余结石发生率差异均无统计学意义(P>0.05)。结论与传统的T管胆总管引流比较,腹腔镜胆总管探查取石术采用一期缝合经胆囊管输尿管导管引流具有较短的手术时间、术后引流管留置时间和术后住院时间的优势,且能减少医疗花费。

Objective To compare the clinical efficacy of ureteral catheter drainage and T-tube drainage in laparoscopic common bile duct exploration and lithotomy.Methods A total of 156 elderly patients with gallbladder stone and choledocholithiasis underwent laparoscopic common bile duct exploration and lithotomy,in which the common bile duct drainage was performed with ureteral catheter and primary suture(group A,64 cases)or with conventional T-tube(group B,92 cases).The operation-related data were compared between the two groups.Results The laparoscopic surgery was successful in all 156 cases without one case transfered to laparotomy.Compared to group B,group A had shorter operation time[(103.1±27.0)minutes vs.(120.8±33.1)minutes],drainage tube indwelling time[(4.3±1.6)days vs.(5.3±2.1)days],postoperative hospital stay[(6.8±2.0)days vs.(8.4±2.3)days],and less hespitalization expenses(P<0.01).There were no significant differences in peri-operative blood loss,bile leakage and residual stones between the two groups(P>0.05).Conclusion Compared with the conventional T tube drainage of common bile duct,the first-stage suture plus common duct ureter catheter drainage in laparoscopic common bile duct exploration and lithotomy has the advantages of shorter operation time,postoperative drainage tube indwelling time and postoperative hospital stay as well as reduced medical costs.