一期缝合与T管引流在腹腔镜联合胆道镜胆总管切开取石术中的效果对比

Comparative analysis of the effect of primary suture and T-tube drainage in laparoscopic choledocholithotomy combined with choledochoscopy

目的探究一期缝合与T管引流在腹腔镜联合胆道镜胆总管切开取石术中的效果。方法92例腹腔镜联合胆道镜胆总管切开取石术患者,根据治疗的方式不同分为A组和B组,各46例。A组采用一期缝合治疗,B组采用T管引流治疗。比较两组手术指标、术后并发症、手术前后的血清炎性因子、肝功能指标。结果两组术中出血量、手术时间比较差异无统计学意义(P>0.05)。A组术后住院时间(10.47±2.38)d、术后排气时间(34.48±6.87)d均短于B组的(16.33±3.12)、(38.16±7.59)d,差异有统计学意义(P<0.05)。A组术后并发症发生率2.17%低于B组的15.22%,差异有统计学意义(P<0.05)。术前、术后1 d、术后3 d,两组C反应蛋白(CRP)、白细胞计数(WBC)水平组间比较,差异无统计学意义(P>0.05)。术后1 d,两组CRP、WBC水平均高于术前,差异有统计学意义(P<0.05)。术后3 d,两组CRP、WBC水平均低于术前、术后1 d,差异有统计学意义(P<0.05)。术前、术后1 d、术后3 d,两组总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)组间比较,差异无统计学意义(P>0.05)。术后1 d,两组TBIL、AST均低于术前,ALT高于术前,差异有统计学意义(P<0.05)。术后3 d,两组TBIL、AST、ALT均低于术前、术后1 d,差异有统计学意义(P<0.05)。结论与T管引流相比,一期缝合应用在腹腔镜联合胆道镜胆总管切开取石术中能够有效缩短住院时间、术后排气时间,降低并发症的发生率,安全性相对较高。

Objective To investigate the effect of primary suture and T-tube drainage in laparoscopic choledocholithotomy combined with choledochoscopy.Methods A total of 92 patients undergoing laparoscopic choledocholithotomy combined with choledochoscopy were divided into group A and group B according to different treatment modality,with 46 cases in each group.Group A was treated with primary suture,and group B was treated with T-tube drainage.The surgical indexes,postoperative complications,serum inflammatory factors and liver function indexes before and after surgery were compared between the two groups.Results There was no statistically significant difference in intraoperative blood loss and operative time between the two groups(P>0.05).The length of hospital stay of(10.47±2.38)d and postoperative exhaust time of(34.48±6.87)d in group A were shorter than those of(16.33±3.12)and(38.16±7.59)d in group B,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in group A was 2.17%,which was lower than that of 15.22%in group B,and the difference was statistically significant(P<0.05).Before surgery,1 d and 3 d after surgery,there was no statistically significant significance between the two groups in terms of C-reactive protein(CRP)and white blood cell count(WBC)(P>0.05).1 d after surgery,CRP and WBC levels in both groups were higher than those before surgery in this group,and the difference was statistically significant(P<0.05).3 d after surgery,CRP and WBC levels in both groups were lower than those before surgery and 1 d after surgery in this group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in total bilirubin(TBIL),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)between the two groups before surgery,1 d and 3 d after surgery(P>0.05).1 d after surgery,TBIL and AST in both group were lower than those before surgery in this group,while ALT was higher than that before surgery in this group,and the differences were statistically significant(P<0.05).3 d after surgery,TBIL,AST and ALT in both groups were lower than those before surgery and 1 d after surgery in this group,and the difference was statistically significant(P<0.05).Conclusion Compared with T tube drainage,the application of primary suture in laparoscopic choledocholithotomy combined with choledochoscopy can effectively shorten the length of hospital stay and postoperative exhaust time,and reduce the incidence of complications,with relatively high safety.