腹腔镜下胆总管切开取石术Ⅰ期缝合与T管引流术的临床分析

Clinical Analysis of Laparoscopic Choledocholithotomy with Primary Suture and T-tube Drainage

目的比较腹腔镜胆总管微创取石术后I期缝合与T管引流的效果,分析选择T管引流的影响因素。方法回顾性分析2021年4月至2022年12月河南中医药大学第五临床医学院(郑州人民医院)120例胆总管结石患者临床资料,根据手术方式不同将其分为缝合组(n=53)与引流组(n=67),缝合组行腹腔镜胆总管微创取石I期缝合(laparoscopic common bile duct exploration and primary suture,LBEPS),引流组行腹腔镜胆总管微创取石T管引流(laparoscopic choledocholithotomy T-tube drainage,LHCTD)。观察两组手术相关指标[术中出血量、手术时间、首次排气时间、引流时间、疼痛程度(VAS)、住院时间]及和术后并发症(腹腔感染、电解质紊乱、胆漏、切口出血、切口感染、肺部感染)发生率。比较两组患者性别、年龄、胆囊切除史、结石数量、胆总管直径、术前相关生化指标[总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DB)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(glutamic oxaloacetic transaminase,AST)]、手术年限等因素差异,采用Logistic分析影响手术方式选择的相关因素。结果两组患者术中出血量、首次排气时间比较差异无统计学意义(P>0.05);缝合组患者住院时间、手术时间、引流时间、VAS评分及并发症总发生率分别为(8.33±1.24)d、(95.64±10.21)min、(7.44±1.12)d、(3.44±0.49)分、2例(3.77%)均低于引流组的(9.21±1.16)d、(100.47±10.36)min、(8.68±1.31)d、(3.72±0.61)分、10例(14.93%),差异有统计学意义(P<0.05);Logistic回归分析显示,结石数量≥2、胆总管直径、手术年限是选择T管引流的独立影响因素(P<0.05)。结论LBEPS可缩短手术时间,降低疼痛程度,术后恢复快。除胆总管多发结石、胆总管直径增大等客观因素外,手术年限导致的观念转变等主观因素也可能影响T管引流的选择。

Objective To compare the effect of primary suture and T-tube drainage after laparoscopic minimally invasive choledocholithotomy,and analyze the influencing factors of T-tube drainage selection.Methods The clinical data of 120 patients with common bile duct stones admitted to the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People′s Hospital)from April 2021 to December 2022 were retrospectively analyzed.According to different surgical methods,the patients were divided into suture group(n=53)and drainage group(n=67).Patients in suture group underwent laparoscopic common bile duct exploration and primary suture(LBEPS),and patients in drainage group underwent laparoscopic choledocholithotomy T-tube drainage(LCHTD).The surgery-related indexes,which include intraoperative blood loss,surgical time,first exhaust time,drainage time,pain degree(VAS)and hospital stay,and incidence rates of postoperative complications,which include abdominal infection,electrolyte imbalance,bile leakage,incision bleeding,incision infection and lung infection,were observed in the two groups.The gender,age,history of cholecystectomy,number of stones,diameter of common bile duct,preoperative related biochemical indicators,including total bilirubin(TBIL),direct bilirubin(DB),alanine aminotransferase(ALT),and aspartate aminotransferase(AST),surgical years and other factors were compared between the two groups.Logistic analysis was used to analyze the related factors affecting the selection of surgical method.Results There were no statistical differences in intraoperative blood loss and first exhaust time between the two groups(P>0.05).The hospital stay,surgical time,drainage time,VAS score and total incidence rate of complications were(8.33±1.24)d,(95.64±10.21)min,(7.44±1.12)d,(3.44±0.49)min,respectively,and 2 cases(3.77%)were lower than those in the drainage group,which were(9.21±1.16)d(100.47±10.36)min,(8.68±1.31)d,(3.72±0.61)min.There was statistical significance in 10 cases(14.93%)(P<0.05);Logistic regression analysis showed that the number of stones≥2,diameter of common bile duct,surgical years were independent influencing factors of the selection of T-tube drainage(P<0.05).Conclusion LBEPS can shorten the surgical time and reduce the pain degree,and improve postoperative recovery.In addition to the objective factors such as multiple common bile duct stones and increased diameter of common bile duct,subjective factors such as concept change caused by the years of surgery may also affect the selection of T-tube drainage.