腹腔镜下胆总管一期缝合在老年胆总管结石病人中的应用效果

Effect of primary suture of the common bile duct under laparoscope in elderly patients with choledocholithiasis

目的比较腹腔镜下胆总管一期缝合与T管引流两种术式对老年胆总管结石病人的治疗效果。方法收集2017年1月至2021年1月南京医科大学附属南京医院普外科收治的老年胆总管结石病人135例,根据胆总管的缝合方式分为一期缝合组和T管引流组,分别对2组病例术前、术中以及术后恢复情况进行对比分析。结果一期缝合组64例,T管引流组71例。2组病人术前相关资料比较,差异无统计学意义(P>0.05);2组平均胆总管直径、管壁厚度、术中出血量比较,差异无统计学意义(P>0.05)。一期缝合组平均术程时长较T管引流组更短(P<0.05)。2组病人术后排气时间和住院时间差异无统计学意义(P>0.05)。一期缝合组和T管引流组术后胆瘘发生率分别为7.81%和4.23%,差异无统计学意义(P>0.05)。一期缝合组出现严重胆瘘后再次手术1例;T管引流组无严重胆瘘致二次手术病例,但有1例病人出院后T管不慎滑脱,另有3例病人来院拔除T管时出现胆瘘。结论腹腔镜下胆总管一期缝合不会导致并发症增多,同时可降低病人术后护理负担,病人治疗后舒适度和满意度高,是治疗老年胆总管结石的一项安全、有效的手段。

Objective To investigate the therapeutic effects of primary suture of the common bile duct under laparoscope and T tube drainage in the treatment of the elderly patients with choledocholithiasis.Methods A total of 135 elderly patients with common bile duct stones admitted to the Department of General Surgery,Nanjing Hospital Affiliated to Nanjing Medical University from January 2017 to January 2021 were enrolled.According to the suture method of the common bile duct,the patients were divided into primary suture group(n=64)and T-tube drainage group(n=71).The general data,preoperative examination data,intraoperative exploration findings and postoperative recovery of the patients in the two groups were compared and analyzed.Results There were no significant differences between the two groups in general conditions,first symptoms,preoperative examinations,the average common bile duct diameter,tube wall thickness and mean intraoperative blood loss(P>0.05).The average duration of the operation in the primary suture group was shorter than that in the T-tube drainage group(P<0.05).There were no significant differences in the time of first ventilation,hospital stay and the incidence rate of postoperative biliary fistula between the two groups(P>0.05).One case received re-operation due to severe biliary fistula in the primary suture group.In the T-tube drainage group,one patient’s T-tube slipped off after being discharged from the hospital,and another 3 cases suffered from a biliary fistula when the T-tube was removed.Conclusions The primary suture of the common bile duct under laparoscope will not lead to an increase of complications,and at the same time,it can improve the comfort and satisfaction of the patients after treatment.It is a safe and effective method for the treatment of the elderly patients with choledocholithiasis.