胆总管切开探查一期缝合术临床应用探讨

The application of primary suture for incision after choledochotomy (A report of 114 cases)

目的探讨胆总管切开探查一期缝合不置T管引流的可行性、手术指征及临床应用价值。方法按适应证选择胆总管结石或可疑结石患者114例,随机分为一期缝合组及T管引流组,一期缝合组探查后不置T管引流,用5-0无损伤可吸收缝线作一期缝合。观察并比较两组患者术后用药情况、恢复情况、术后并发症、住院时间及费用情况,并进行随访。结果一期缝合组术后抗生素使用时间、平均输液量、输液时间、肠功能恢复时间、下床活动时间、平均住院时间及住院费用均较T管引流组减少(均P<0.05);随访6个月～2.5年,未发现有胆管狭窄的临床征象,术后并发症发生率与T管引流组的差别无显著性意义(P>0.05)。结论只要正确掌握手术适应证与缝合技巧,胆总管切开探查一期缝合术是安全可行的,有推广应用价值。

Objective To evaluate the indication and feasibility of primary suture after the common bile duct exploration(CBDE). Methods One hundred and fourteen cases of choledocholithiasis were chosen for primary suture by 5-0 viger after CBDE. Post-operative complications and the length of hospital stay were compared with those with T-tube drainage. Results Compared with T-tube drainage group, the complication rate was reduced and the length of hospital stay in primary suture group was shortened. And also the mortality and operation time were decreased significantly. Conclusion The primary suture after CBDE in selected cases is proved safe and reliable.