腹腔镜胆总管取石一期缝合术与T管引流术对胆结石的临床疗效比较

Compare of clinical efficacy of laparoscopic choledocholithotomy with one-stage suture and T-tube drainage in the treatment of gallstones

目的比较腹腔镜胆总管取石术中一期缝合术与T管引流术的临床疗效。方法选取2019年2月至2021年5月于启东市人民医院行腹腔镜下胆总管取石术的76例患者作为研究对象,根据治疗方法不同分为引流组与缝合组,每组38例。缝合组采用一期缝合术,引流组采用T管引流术,比较两组首次排气时间、住院时间、住院费用及手术前后肝功能指标[总胆红素(TBIL)、谷草转氨酶(AST)与谷丙转氨酶(ALT)]、疼痛程度、术后并发症发生情况。结果缝合组首次排气时间、住院时间均短于引流组,住院费用少于引流组,差异有统计学意义(P<0.05)。术前、术后3 d,两组TBIL、AST、ALT水平比较差异无统计学意义;术后3 d,两组TBIL、AST、ALT水平均低于术前,差异有统计学意义(P<0.05)。缝合组视觉模拟评分法(VAS)评分低于引流组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。结论与T管引流术相比,腹腔镜胆总管取石一期缝合术治疗胆结石临床疗效显著,可缩短患者住院时间、首次排气时间,减少其住院费用,避免患者长时间携带T管的痛苦,且两者肝功能均可短时间恢复,安全性较高。

Objective To compare the clinical efficacy of laparoscopic choledocholithotomy with one-stage suture and T-tube drainage in the treatment of gallstones.Methods 76 patients who underwent laparoscopic choledocholithotomy in Qidong People's Hospital from February 2019 to May 2021 were selected as the study subjects,and they were divided into the drainage group and the suture group according to different treatment methods,with 38 cases in each group.The suture group was treated with one-stage suture,and the drainage group was treated with T-tube drainage,the first exhaust time,hospitalization time,hospitalization cost,liver function indexes(total bilirubin[TBIL],aspartate aminotransferase[AST]and alanine aminotransferase[ALT])before and after operation,pain degree and postoperative complications were compared between the two groups.Results The first exhaust time and hospitalization time in the suture group were shorter than those in the drainage group,and the hospitalization cost was less than that in the drainage group,and the differences were statistically significant(P<0.05).There were no significant differences in the levels of TBIL,AST and ALT between the two groups before operation and 3 d after operation;3 d after operation,the levels of TBIL,AST and ALT of the two groups were lower than those before operation,and the differences were statistically significant(P<0.05).The visual analogue scale(VAS)score in the suture group was lower than that in the drainage group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups.Conclusion Compared with T-tube drainage,laparoscopic choledocholithotomy and primary suture for cholelithiasis has significant clinical effect,which can shorten the hospitalization time,the first exhaust time,reduce the cost of hospitalization,avoid the pain of patients carrying T-tube for a long time,and the liver function of both can be restored in a short time,and the safety is high.