腹腔镜胆总管探查胆总管一期缝合与T管引流治疗胆总管结石的效果对比

The effect comparison of treatment of choledocholith by laparoscopic common bile duct exploration with primary suture and T-tube drainage

目的 探讨腹腔镜胆总管探查胆总管一期缝合与T管引流治疗胆总管结石的效果。方法 40例行腹腔镜胆总管探查的胆总管结石患者作为研究对象,依据治疗方法不同分为一期缝合组和T管引流组,每组20例。一期缝合组采用一期缝合治疗, T管引流组采用T管引流治疗。比较两组患者手术时间、术中出血量、胃肠功能恢复时间、住院时间,术前及术后第3天肝功能指标和炎性指标变化情况,并发症发生情况。结果 两组患者术中出血量比较,差异无统计学意义(P>0.05);一期缝合组手术时间(91.06±9.08)min、胃肠功能恢复时间(1.20±0.24)d、住院时间(7.22±1.70)d均短于T管引流组的(108.84±10.67)min、(2.10±0.48)d、(9.57±1.86)d,差异均有统计学意义(P<0.05)。两组患者术前总胆红素(TBIL)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷丙转氨酶(ALT)、谷氨酰基转移酶(GGT)、C反应蛋白(CRP)、白细胞介素-1β(IL-1β)比较,差异无统计学意义(P>0.05);术后第3天,两组患者TBIL、AST、ALP、ALT、GGT、CRP、IL-1β均低于术前,一期缝合组患者TBIL(19.26±6.74)μmol/L、AST(59.82±15.36)U/L、ALP(139.18±18.13)U/L、ALT(28.47±8.92)U/L、GGT(90.12±9.28)U/L、CRP(41.46±5.02)mg/L、IL-1β(72.58±5.64)pg/ml均低于T管引流组的(25.31±5.08)μmol/L、(85.47±16.19)U/L、(154.24±7.09)U/L、(36.78±10.12)U/L、(99.36±6.46)U/L、(52.84±5.19)mg/L、(84.46±6.01)pg/ml,差异均有统计学意义(P<0.05)。一期缝合组患者并发症发生率5%均低于T管引流组的30%,差异有统计学意义(P<0.05)。结论 腹腔镜胆总管探查胆总管一期缝合治疗胆总管结石患者手术时间短,恢复快,炎性指标和肝功能指标改善明显,并发症少。

Objective To explore the effect of laparoscopic common bile duct exploration with primary suture and T-tube drainage in treatment of choledocholith.Methods 40 cases of choledocholith patients receiving laparoscopic common bile duct exploration were selected as study subjects,and they were divided into primary suture group and T-tube drainage group by different treatment methods,with 20 cases in each group.The primary suture group was treated by primary suture,and the T-tube drainage group was treated by T-tube drainage.Comparison was made on operation time,intraoperative blood loss,recovery time of gastrointestinal function,hospitalization time,changes of liver function indicators and inflammatory indicators before and on the 3rd day after surgery,and complications between the two groups.Results There was no statistically significant difference in intraoperative blood loss between the two groups(P>0.05).The operation time,recovery time of gastrointestinal function and hospitalization time in the primary suture group were(91.06±9.08)min,(1.20±0.24)d and(7.22±1.70)d,which were shorter than(108.84±10.67)min,(2.10±0.48)d and(9.57±1.86)d in the T-tube drainage group.The difference was statistically significant(P<0.05).Before surgery,there was no statistically significant difference between the two groups in terms of total bilirubin(TBIL),aspartate transaminase(AST),alkaline phosphatase(ALP),alanine aminotrasferase(ALT),γ-glutamyltransferase(GGT),C-reactive protein(CRP)and interleukin-1β(IL-1β)(P>0.05).On the 3rd day after surgery,TBIL,AST,ALP,ALT,GGT,CRP and IL-1βin both groups were all lower than those before surgery;and patients in the primary suture group had TBIL of(19.26±6.74)μmol/L,AST of(59.82±15.36)U/L,ALP of(139.18±18.13)U/L,ALT of(28.47±8.92)U/L,GGT of(90.12±9.28)U/L,CRP of(41.46±5.02)mg/L,IL-1βof(72.58±5.64)pg/ml,which were lower than(25.31±5.08)μmol/L,(85.47±16.19)U/L,(154.24±7.09)U/L,(36.78±10.12)U/L,(99.36±6.46)U/L,(52.84±5.19)mg/L,(84.46±6.01)pg/ml in T-tube drainage group;the difference was statistically significant(P<0.05).The complication rate of 5%in the primary suture group was lower than 30%in the T-tube drainage group,and the differences were statistically significant(P<0.05).Conclusion Laparoscopic common bile duct exploration with primary suture for the treatment of choledocholith has short operation time,rapid recovery,significant improvement in inflammatory and liver function indices,and few complications.