多腔T型管在腹腔镜胆总管切开及胆道镜下液电碎石术中的应用

目的探讨＂多腔T型管＂在腹腔镜胆总管切开及胆道镜下液电碎石术中的应用效果。方法选择2012年6月至2013年12月收治的60例肝内外胆管结石患者。60例患者按随机数字表法分为治疗组（30例）和对照组（30例）,均采用腹腔镜胆总管切开、胆道镜下液电碎石术,治疗组术中放置多腔T型管;对照组术中放置普通T型管。记录两组患者手术时间、术中出血量、术后首次肛门排气时间、首次肛门排便时间、术后胆汁丢失量及平均术后住院日和住院总费用;记录并发症发生情况（包括切口感染、电解质紊乱、反流性胆管炎、胆漏等）及术后2个月结石残留率、术后6个月结石复发情况。结果 （1）治疗组手术时间、术中出血量与对照组比较差异无统计学意义（P均〉0.05）。治疗组术后首次肛门排气时间、首次肛门排便时间、术后胆汁丢失总量、术后平均住院天数、住院总费用均少于对照组,差异均有统计学意义（P〈0.05或P〈0.01）。（2）治疗组术后出现并发症6例（20.00%）,包括切口感染2例、电解质紊乱2例、反流性胆管炎1例、胆漏1例;对照组出现术后并发症16例（53.33%）,包括切口感染3例、电解质紊乱7例、反流性胆管炎4例、胆漏2例。两组并发症发生率比较差异有统计学意义（P〈0.01）。两组并发症均经保守治疗治愈。（3）治疗组结石残留率（3.33%）稍低于对照组（20.00%）,两组比较差异无统计学意义（P〉0.05）。术后随访6个月,两组均未发现结石复发。结论在腹腔镜胆总管切开、胆道镜下液电碎石术中放置多腔T型管,具有术后恢复较快、并发症较少、术后结石残留率低等优势。

Application of multi-cavity T tube in choledochoscopic common bile duct exploration and electrohydraulic lithotripsy under cholangioscopy

Objective To investigate application effect of multi-cavity T tube in choledochoscopic common bile duct exploration and electrohydraulic lithotripsy under cholangioscopy. Methods Sixty patients with intrahepatic and extrahepatic bile duct stones underwent surgery in Hepatobiliary Surgery Department of the First Affiliated Hospital of Hunan Traditional Chinese Medical College from June 2012 to December 2013 were retrospectively studied. 60 cases of intrahepatic and extrahepatic bile duct stones were randomly divided into the treatment group（ 30 cases） and control group（ 30 cases）,all the patients underwent laparoscopic common bile duct exploration and choledochoscope electrohydraulic lithotripsy. The treatment group was placed with multi-cavity T tube during surgery,and the control group was placed with ordinary T tube. Operation time,bleeding volume during operation,first flatus time,first defecation time,total bile loss,average postoperative hospitalization days and total cost of hospitalization were recorded. Complications（ including incision infection,electrolyte disturbance,reflux cholangitis and bile leakage） occurrence rates at 2 months after operation,as well as postoperative residual stone rates,and postoperative stone recurrence rates at 6 months after operation were also recorded. Results No significant difference of operative time and blood loss was found in two groups（ all P〉0. 05）.Earlier first flatus and first defecation time,less postoperative biliary total loss,shorter average hospital stay after surgery and less hospital costs were found in treatment group（ all P〈0. 05）. Six cases（ 20. 00%） of postoperative complications occurred in treatment group,including 2 cases of wound infection,2 cases of electrolyte imbalance,1 case of reflux cholangitis and 1 case of bile leakage,while 16 cases（ 53. 33%） of postoperative complications occurred in control group,including 3 cases of wound infection,7 cases of electrolyte imbalance,4 cases reflux cholangitis and 2 cases of bi