腹腔镜下联合胆道镜胆总管切开取石一期缝合与T管引流的临床分析

Clinical analysis of laparoscopic choledochoscopic choledocholithotomy with primary suture and T-tube drainage

目的分析腹腔镜下联合胆道镜胆总管切开取石一期缝合与T管引流的临床疗效,为临床治疗提供参考。方法2015年1月至2017年12月,65例行腹腔镜胆囊切除、胆总管切开取石、胆道镜探查的胆总管结石患者依据手术方式分为缝合组(35例,行胆总管--期缝合)、引流组(30例,行T管引流)。经Excel表采用双人双录、专人核对、及时备份等方式收集并对比两组手术时间、术中出血、术后肛门排气时间、术后住院时间、并发症(结石残留、胆管狭窄、胆瘘、复发等)、复查等资料。结果(1)手术时间、术后住院时间:缝合组短于引流组(P<0.05)。(2)术中出血、术后肛门排气时间:两组接近(P>0.05)。(3)经(6~29)个月随访,两组未见胆总管结石复发,各新增1例无症状性肝内胆管结石。并发症率:两组相当(5.71%vs3.33%,P>0.05)。结论与T管引流相比,腹腔镜下联合胆道镜胆总管切开取石--期缝合手术快.住院短,但二者适应症不尽相同,治疗中应加以选择。

Objective To analyze the clinical efeet of laparoscopic choledocholithotomy combined with choledochoscope with primary suture and T-tube drainage,so as to provide reference for elinical treatment.Methods From January 2015 to December 2017,65 patients with choledocholithiasis who underwent laparoscopic chleystectomy,choledochotomy and choledochoscopic explora-tion were divided into suture group(35 cases,primary suture of common bile duet)and drainage group(30 cases,T tube drainage).The data of operation time,bleeding,anal exhaust time,hospital stay,complications(residual stones,bile duct stenosis,biliary fistu-la,recurrence,etc.)were collected and compared between the two groups by Excel table.Results Operation time and hospitalization time were shorter in suture group than in drainage group(P<0.05).(2)Hemorthage during operation and anal exhaust time after operation;the two groups were close(P>0.05).(3)Afer a follow-up of 6-29 months,no recurrence of common bile duct stones was found in the two groups,and 1 case of asymptomatie intrahepatic bile duct stones was added in each group.Complication rate:the two groups were similar(5.71%vs 3.33%,P>0.05).Conclusion:compared with T-tube drainage,laparoscopic choledochoscopic choledocholithotomy with primary suture is faster and shorter in hospital,but the indications of the two methods are diferent,so the treat-ment should be selected.