腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析

目的 评价国内腹主动脉瘤(AAA)开腹手术与腔内修复术围手术期情况.方法 检索2000年1月-2009年1月国内临床中心以中英文公开发表的AAA开腹手术与腔内修复术围手术期情况的非随机对照(NRCs)研究文献,提取相关指标后综合分析.结果 6篇NRCs资料质量评分为18.83±0.98.与开腹手术相比,腔内修复术术中失血量(WMD=-689.24 mL,95%CI为-1 077.61～-300.88,P＜0.05),术中输血量(WMD=-440.01 mL,95%CI为-488.96～-391.06,P＜0.05),术后禁食时间(WMD=-5.21 d,95% CI 为-6.23～-4.19,P＜0.05),术后ICU观察时间(WMD=-1.79 d,95% CI 为-2.21～-1.46,P＜0.05),术后住院时间(WMD:-5.19 d,95% CI 为-7.09～-3.28,P＜0.05)均显著减少.两种治疗方法 的手术时间(WMD=-35.86 min,95% CI 为-85.01～1 3.28,P=0.15)及并发症发生率(OR=0.92,95% CI 为0.55～1.53,P=0.74)差异无统计学意义.结论 国内NRCs资料的荟萃分析显示,腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点,但在手术时间及减少近期并发症方面无显著优势.     

优化老年患者胸部手术围手术期管理策略的临床研究

目的 通过优化老年患者开胸手术围手术期管理模式提高手术疗效.方法 对58例≥65岁开胸手术患者进行前瞻性围手术期呼吸、循环监测,观察术后并发症发生情况,并与同期56例<65岁患者对照.在此基础上建立优化围手术期管理模式,前瞻性治疗179例≥65岁病例,并与同期477例非老年病例比较.结果 后期优化管理组老年病例术后住院病死率(4.9%vs.1.1%,P=0.033)及总体并发症发生率(58.6%vs.21.8%,P<0.01)均明显低于前期监测研究组,尤其是以心血管和呼吸为主的功能性并发症发生率明显降低(51.7%vs.14.5%,P<0.01),而外科操作性并发症发生率无明显差异.与前期监测研究组相比,后期优化管理组急性肺损伤(17.2%vs.6.7%,P=0.016)和呼吸衰竭发生率(6.9%vs.1.7%,P=0.041)均下降;术后早期心律失常发生率亦有降低(20.7%vs.7.3%,P=0.004).结论 通过深入术前功能评估、加强手术麻醉中保护性肺通气、术后严格控制液体出入量以及及时的介人性呼吸循环管理、优化老年患者的围手术期管理模式,可明显提高老年患者胸部手术的疗效.     

腹主动脉瘤开腹手术与腔内治疗的比较

目的：比较腹主动脉瘤腔内修复术与开放手术的疗效。方法：对35例肾下型腹主动脉瘤患者分别进行开放手术（21例）与腔内修复术（14例）治疗,比较两组术前评估、手术、围手术期及术后随访情况。结果：腔内修复组年龄较高（P〈0.05）,手术时间、术中出血量、输血量较开腹手术低（P〈0.01）,所需营养支持、监护、卧床时间短（P〈0.01）,围手术期并发症发生率低（P〈0.05）,但远期并发症发生率较高（P〈0.05）。结论：腹主动脉瘤腔内支架治疗较为安全,创伤更小,患者恢复速度较快,适合于高龄及合并症较多的患者。传统开放手术适于年轻、合并症少及无法行腔内修复术的患者。     

腹腔镜与开腹手术在T4a期结肠癌治疗中的临床疗效观察

目的评价腹腔镜与开腹手术在T4a期结肠癌治疗中的临床疗效。方法选取2016年4月至2018年10月接受手术治疗的243例T4a期结肠癌患者,分为腔镜组94例和开腹组149例。使用统计软件SPSS23.0进行数据处理,术后30 d内并发症发生率及术后3年疗效比较使用χ~2检验;术中术后各项指标以■表示,采用独立t检验,以P0.05表示差异有统计学意义。结果腔镜组术中出血量、切口长度、术后排便时间、引流管拔除时间、进食流质时间、尿管拔除时间、术后住院时间均少于开腹组,两组对比差异有统计学意义(P0.05);腔镜组的手术时间大于开腹组(P0.05);淋巴结清扫个数两组差异无统计学意义(P0.05);术后30 d并发症发生率腔镜组(7.4%)低于开腹组(16.8%)(P0.05);随访时间为6～36个月,平均18.3个月,腔镜组和开腹组局部复发率为(4.3%vs.5.4%),远处转移率为(5.3%vs.4.7%),死亡率为(9.6%vs.10.1%),两组对比差异均无统计学意义(P0.05)。结论对于T4a期结肠癌患者而言腔镜手术的短期临床疗效更显著,患者受到的痛苦更少,恢复更快,术后并发症发生率小于开腹术。     

破裂性腹主动脉瘤的急救及围手术期危险因素：附27例报告

目的:探讨破裂性腹主动脉瘤(r AAA)的急救经验及围手术期危险因素。方法:回顾性分析2007年1月—2015年9月间救治的27例r AAA患者的临床资料,其中男20例,女7例;中位年龄72岁;18例行开腹手术,6例腔内治疗(包括1例行杂交手术)。总结诊治过程、围术期情况及随访结果,并分析影响预后的因素。结果:术前死亡3例,术中死亡1例,术后死亡9例,术后死因有急性肾衰、急性呼衰、腹腔间隔室综合征、心肌梗塞、消化道出血,最终均出现多器官功能衰竭。总体抢救成功率为51.9%(14/27),开腹手术和腔内治疗成功率分别为50.0%(9/18)和83.3%(5/6)。围术期存活和死亡患者间的临床参数比较显示,发病到就诊时间、术前收缩压、术前肌酐、术中出血量及输血量、术中尿量的差异有统计学意义(均P0.05)。结论:r AAA病情危重,病死率高,尽早确诊后应紧急外科治疗控制出血,加强围术期管理。在r AAA的救治中,腔内治疗是一种有效的治疗手段。     

腹主动脉瘤腔内修复与开放手术疗效初探

目的 比较腹主动脉瘤开放手术与腔内治疗的效果.方法 对42例分别行开放手术和腔内修复的腹主动脉瘤患者的手术相关情况、围手术期并发症发生率、病死率、随访情况以及相关的费用进行对比分析.结果 腔内修复组手术时间、术中出血量、输血量均少于开放手术组(P<0.01),两组围手术期并发症差异无统计学意义(P>0.05),两组术后2年生存率差异无统计学意义(P>0.05),但腔内修复组术后远期并发症发生率高于开放手术组(P<0.01).住院费用腔内修复组明显高于开放手术组(P<0.01).结论 腹主动脉瘤腔内修复术具有手术时间短、微创的特点,但具有较高的远期并发症,开放手术组6个月生存质量优于腔内修复组.     

完全腹腔镜与开腹全胃切除的疗效及术后并发症分析

目的:探讨完全腹腔镜与开腹胃癌根治术术中、术后情况的差异,以及并发症发生的影响因素。方法:回顾性分析2014年1月—2017年1月330例行根治性全胃切除术患者资料,其中150例行完全腹腔镜手术(腔镜组),另外180例行开腹手术(开放组),比较两组患者相关临床指标以及并发症情况,并分析并发症发生的影响因素。结果:两组患者术前资料具有可比性。与开放组比较,腔镜组手术时间延长,术中出血量、术后肠道功能恢复时间及术后住院时间均明显减少(均P0.05);淋巴结清扫数目两组间无统计学差异(P0.05);腔镜组术后的总并发症发生率明显低于开放组(8.67%vs.32.22%,P0.05),其中主要是在术后肠梗阻、腹腔出血、切口感染等外科并发症发生率低于开放组(6.67%vs.31.66%,P0.05),而两组非外科并发症总发生率无统计学差异(13.32%vs.8.34%,P0.05)。单因素分析显示,年龄、BMI、手术时间、术前患者的血清蛋白及血红蛋白水平、肿瘤大小、淋巴结转移、术前合并症均并为发症发生的影响因素(均P0.05)。结论:完全腹腔镜下胃癌根治术的创伤小,术后恢复快,总的并发症控制优于开放性手术,推荐临床应用。     

高风险患者腹主动脉瘤手术与腔内治疗效果的比较

目的 比较高风险患者腹主动脉瘤(abdominal aortic aneurysm,AAA)手术治疗(opensurgical repair,OSR)与腔内治疗(endovascular aneurysm repair,EVAR)的效果,探讨高风险患者AAA治疗方式的选择.方法 利用(customized probability index,CPI)危险评分方法[1]筛选出我院1998年至2008年高风险患者55例,比较OSR组(20例)与EVAR组(35例)围手术期及术后近期结果.结果 OSR组随访率100%,平均随访6年3个月.EVAR组随访率94%,平均随访5年10个月.(1)手术时间高风险患者EVAR组(3.1±0.6)h短于OSR组[(4.9±0.9)h(P<0.05)];(2)EVAR组术中出血、ICU时间和住院时间均短于OSR组(P<0.01);(3)围手术期死亡率EVAR组(2.86%)明显低于OSR组(15.00%);(4)术后并发症发生率EVAR组(17%)明显低于OSR组(40%);(5)EVAR组术后并发症主要为内漏(8.57%);(6)OSR组并发症主要为心脏相关性疾病(25%).结论 EVAR对于高风险患者AAA的治疗可以更少的导致围手术期心血管事件的发生,降低围手术期的死亡率和并发症发生率.CPI可以相对准确评估血管手术围手术期死亡率和并发症的发生率,可用于指导围手术期的治疗策略.     

伴重度阻塞性黄疸胰十二指肠切除术术前引流对术后并发症影响的研究

目的:研究术前引流对重度阻塞性黄疸患者胰十二指肠切除术后并发症的影响。方法:2010年2月—2015年10月98例重度阻塞性黄疸(总胆红素300μmol/L)行胰十二指肠切除术的患者根据是否行术前引流、分为对照组(52例)和术前引流组(46例),比较两组患者手术时间、术中出血量、术后并发症发生率、病死率及术后住院时间。结果:两组患者一般资料、术前检查结果及病理结果无明显差异(P0.05)。对照组患者手术时间明显长于术前引流组患者[(379.44±88.57)min vs(346.98±57.17)min,P0.05]。对照组患者术中出血量明显高于术前引流组患者[(346.98±57.17)mL vs(297.83±139.57)mL,P0.05]。对照组与术前引流组患者病死率无明显差异(3.85%vs 2.17%,P0.05)。两组患者总体并发症发生率无明显差异(53.85%vs 43.48%,P0.05),但对照组患者胰瘘发生率明显高于术前引流组患者(30.77%vs 13.04%,P0.05)。结论:术前引流可降低胰十二指肠切除术手术时间、术中出血量及术后胰瘘发生率,且病死率及总体并发症发生率与对照组无明显差别。对于重度阻塞性黄疸患者应考虑行术前引流     

腔内修复术与开腹手术治疗腹主动脉瘤围手术期疗效的Meta分析

目的：系统评价方法比较血管腔内修复术与开腹术手术治疗腹主动脉瘤（AAA）的围手术期疗效。方法：检索国内外文献数据库,收集血管腔内修复术与开腹术手术治疗AAA的随机对照试验,采用RevMan5.1软件进行Meta分析。结果：共纳入7个随机对照试验,8篇文献,共2 807例患者,其中行血管腔内修复术1?433例（腔内组）,开腹手术1 374例（开腹组）。Meta分析结果显示,腔内组较开腹组手术时间减少（SMD=-0.87,95% CI=-1.43--0.31,P=0.002）,术中输血量减少（SMD=-0.83,95% CI=-0.94--0.72,P<0.00001）,ICU监护时间缩短（MD=-38.11,95% CI=-48.61--27.61,P<0.00001）,术后住院时间缩短（MD=-5.11,95% CI=-6.26--3.95,P<0.00001）,术后30 d病死例数降低（OR=0.30,95% CI=0.16-0.55,P=0.0001）。结论：腔内修复治疗AAA较开腹手术具有创伤小、失血少、术后恢复快的优点,围手术期具有较大优势,但长期预后有待研究。

     

Perioperative mangement of surgery for abdominal aortic aneurysm associated with coronary artery disease

BACKGROUND: Patients undergoing abdominal aortic aneurysm (AAA) surgery are at increased risk of perioperative cardiovascular complications due to underlying coronary artery disease (CAD). We determined retrospectively the incidence of CAD and the influence of coronary revascularization and perioperative cardiovascular complications in patients for AAA surgery. METHODS: Routine coronary angiography (CAG) was performed in 159 patients prior to elective AAA surgery to estimate the presence of CAD. To compare risk factors and perioperative cardiovascular complications the patients were divided at the time of CAG into three groups: previously diagnosed CAD, newly diagnosed CAD and non-CAD. RESULTS: Preoperative CAG found 129 patients (81%) with CAD. Among newly diagnosed patients 82% were asymptomatic of CAD. Forty-four patients (28%) underwent coronary revascularization (17 percutaneous coronary intervention, 3 preoperative coronary artery bypass grafting, and 24 combined coronary artery bypass grafting). Perioperative cardiac complications occurred in 35 patients (22%). No significant difference was found among the three groups in the incidence of perioperative cardiovascular complications. Two patients with severe CAD not treated with coronary revascularization died of cardiac events. CONCLUSIONS: Perioperative management and coronary revascularization should be carried out with more cautions in AAA patients to reduce the incidence of cardiovascular complications after AAA surgery.     

Myocardial damage in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair.

OBJECTIVE: Dobutamine stress echocardiography (DSE) provides an objective assessment of the presence and extent of coronary artery disease. Therefore we compared cardiac outcome in patients at high-cardiac risk undergoing open or endovascular repair of infrarenal AAA using preoperative DSE results. METHODS: Consecutive patients with >or=3 cardiac risk factors (age >70 years, angina pectoris, myocardial infarction, heart failure, stroke, renal failure, and diabetes mellitus) undergoing infrarenal AAA repair were reviewed retrospectively. All underwent cardiac stress testing using DSE. Postoperatively data on troponin release and ECG were collected on day 1, 3, 7, before discharge, and on day 30. The main outcome measures were perioperative myocardial damage and myocardial infarction or cardiovascular death. RESULTS: All 77 patients (39 endovascular, 38 open) had a history of cardiac disease. The number and type of cardiac risk factors were similar in both groups. Also DSE results were similar: 55 vs 56%, 24 vs 28%, and 21 vs 18% had no, limited, or extensive stress induced myocardial ischemia respectively. The incidence of perioperative myocardial damage (47% vs 13%, p=0.001) and the combination of myocardial infarction or cardiovascular death (13% vs 0%, p=0.02) was significantly lower in patients receiving endovascular repair. CONCLUSION: In patients with similar high cardiac risk, endovascular repair of infrarenal aortic aneurysms is associated with a reduced incidence of perioperative myocardial damage.     

Outcome after Simultaneous Abdominal Aortic Aneurysm Repair and Aortocoronary Bypass

Myocardial infarction remains the leading cause of early and late death after abdominal aortic aneurysm (AAA) repair. Myocardial revascularization is staged either before or concomitant with AAA resection, but results are far from uniform. We retrospectively analyzed our experience with patients who underwent concomitant AAA resection and aortocoronary bypass (ACB) to examine the factors affecting early morbidity/mortality and early results. Forty-two patients (all men; mean age, 67.2 years) underwent simultaneous ACB grafting and AAA repair between 1975 and 1998. All were managed postoperatively in the cardiothoracic intensive care unit (mean stay, 6.1 days). The mean total hospital stay was 17.2 days. Two died in the early postoperative period (4.8%): 1 of sustained myocardial failure following a third ACB, and 1 of coagulopathy after concomitant ACB, aortic valve replacement, and AAA. One patient developed a nonfatal MI on postoperative day 3. The incidence of wound and bleeding complications was higher for patients undergoing both ACB and AAA repair than for patients undergoing AAA resection alone. On follow-up (mean, 10 years; range, 7 months to 15 years), only 2 of 10 late deaths were due to cardiovascular causes. We believe that concomitant myocardial revascularization is warranted in select patients requiring elective or urgent AAA resection in order to decrease perioperative risk and improve late survival. Cardiac failure or ischemia during aortic surgery can be prevented by proper perfusion with or without cardiopulmonary bypass. In patients undergoing simultaneous procedures, the increased risk is related to the severity of the vascular and coronary artery disease and not to the combined operations.     

Predictors of Early Discharge following Open Abdominal Aortic Aneurysm Repair

Patients undergoing endovascular abdominal aortic aneurysm (AAA) repair have lower perioperative morbidity and leave the hospital earlier than patients undergoing open repair. However, potential complications require continuous surveillance of endografts and there are few data regarding their long-term fate. If an open operation were well tolerated, this might be a preferable alternative. The purpose of this study was to identify patients with lower morbidity and shorter hospital stay following open AAA repair and to analyze factors that might point to open repair as the preferred approach. We performed a retrospective review of all patients who underwent AAA repair between 1995 and 2000 at our institution. All patients with ruptured aneurysms and those that required renal, celiac, or superior mesenteric reconstructions during the AAA repair were excluded. Patient demographics, preoperative comorbid conditions, intraoperative data, and postoperative complications were analyzed in detail. A total of 115 patients fulfilled the inclusion criteria. There was only one perioperative death (0.9%). The mean hospital stay was 8.1 days. A history of chronic obstructive pulmonary disease (COPD) and longer operative time were independent factors associated with prolonged hospital stay. Forty-one patients (35.6%) left the hospital in 5 or less days. Compared to the group with hospital stay >5 days, these patients had a lower incidence of COPD (7.3% vs. 25.7%, p < 0.05) and smaller-size AAAs (5.6 vs. 6.4 cm, p < 0.0001), and were more often operated on via a retroperitoneal approach (61% vs. 40.5%, p < 0.05). Their time in the operating room was less (3.5 vs. 4.5 hr, p < 0.0001), and they had less estimated blood loss (750 vs. 1500 cc, p < 0.001) and fewer transfusions (0.95 vs. 2.45 units, p < 0.0001). Patients without COPD and smaller AAAs that can be repaired via a retroperitoneal approach have a lower incidence of perioperative complications and a shorter hospital stay following open AAA repair. Until long-term results for endografts are available, our data suggest that these patients are well served with an open repair.     

肾下腹主动脉重建术治疗腹主动脉瘤和主髂动脉闭塞症的风险比较

目的探讨肾下腹主动脉重建在腹主动脉瘤 (abdominalaorticaneurysm ,AAA)和主髂动脉闭塞症 (aortoiliacocclusivedisease ,AIOD)中的手术风险 ,分析造成差异的可能原因。方法回顾性总结 340例 (2 2 2例腹主动脉瘤和 118例主髂动脉闭塞症 )肾下腹主动脉重建手术的临床资料。结果手术总死亡率为 7 6 % ,其中主髂动脉闭塞症手术死亡率为 11 9% ,明显高于腹主动脉瘤的5 4 % (χ2 =4 5 5 1,P <0 0 5 )。手术总并发症发生率为 2 2 4 % ,其中主髂动脉闭塞症为 2 8 8% ,明显高于腹主动脉瘤的 18 9% (χ2 =4 346 ,P <0 0 5 )。多脏器功能衰竭为两组中主要的死亡原因 ,呼吸系统感染为最主要的术后并发症。危险因素中 ,男女性别比、吸烟状况、糖尿病 3个因素在AOID组明显高于AAA组 (P均 <0 0 1) ,高血压、心电图ST段改变、肺功能不全等AIOD组也高于AAA组 ,但差异无显著意义。年龄构成、肾功能不全和手术时间等两组无统计学差异 ,输血量AAA组明显高于AIOD组。结论主髂动脉闭塞症手术风险高于腹主动脉瘤 ,吸烟、糖尿病、重要脏器功能状况是造成手术风险差异的主要原因。     

Current results of elective aortic reconstruction for aneurysmal and occlusive disease

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.     

置管溶栓与机械吸栓治疗急性下肢动脉血栓的安全性与疗效比较

目的:比较机械吸栓(PMT)与置管溶栓(CDT)治疗急性下肢动脉血栓的安全性与临床疗效。方法:回顾性分析2015年7月—2018年3月因急性下肢动脉血栓形成接受腔内介入治疗的67例患者的临床资料。其中37例行PMT治疗(PMT组),30例行CDT治疗(CDT组),比较两组的围手术期相关指标。结果:两组患者术前指标、术后需进一步行球囊扩张+支架植入的患者例数、一期血管开通率以及12个月一期血管通畅率均无统计学差异(均P0.05)。PMT组平均住院时间明显低于CDT组[(5.8±0.8)d vs.(8.9±0.6)d,P0.05],但平均住院费用高于CDT组[(7.0±1.1)万元vs.(4.8±0.8)万元,P0.05]。两组患者术后严重出血、术后截肢、穿刺处血肿、穿刺处感染、肾功能不全发生率均无统计学差异(均P0.05),但PMT组术后总并发症发生率明显低于CDT组(5.4%vs. 26.7%,P0.05)。结论:PMT与CDT在治疗急性下肢动脉血栓方面同样是安全、有效的。PMT相对于CDT术后总并发症发生率和住院时间减少,但住院费用增加。     

腹主动脉瘤腔内修复术中输送器回撤困难的处理对策

目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)中输送器回撤困难的原因处理对策。方法:回顾性分析2008年1月—2016年4月305例行EVAR的AAA患者临床资料,分析术中输送器回撤困难发生的原因及相应对策。结果:305例患者中,共21例(6.89%)出现输送器回撤困难,其中复杂AAA 18例,非复杂AAA 3例;分体式支架修复17例,一体化支架修复4例,差异均有统计学意义(85.7%vs.14.3%;81.0%vs.19.0%,均P0.05)。18例出现回撤困难复杂AAA患者均存在瘤颈严重扭曲,其中7例存在2个以上连续扭曲瘤颈,2例扭曲同时伴有短瘤颈;在所有存在扭曲瘤颈的患者中,有2个以上连续扭曲瘤颈患者回撤困难的发生率最高(P0.05)。21例回撤困难情况通过综合运用相关处理对策均成功解决。结论:复杂AAA的EVAR发生输送器回撤困难情况并不少见,尤其是存在2个以上连续扭曲瘤颈的更易发生,通过综合运用相应对策可有效处理。     

经皮经肝穿刺胆道引流术在腹腔镜下胆道探查术后一期缝合中的应用价值

目的:探讨经皮经肝穿刺胆道引流术(PTCD)在腹腔镜下胆道探查术后一期缝合中的应用价值。方法:回顾性分析2015年6月—2017年6月昆明医科大学第二附属医院肝胆胰外科三病区收治的65例胆囊结石伴胆总管结石行腹腔镜下胆道探查术并一期缝合患者的临床资料。其中33例术前行PTCD治疗,术后保留PTCD管引流(PTCD组),32例未行PTCD治疗(非PTCD组)。比较两组患者的相关临床指标。结果:65例患者手术均成功,无中转开腹。与非PTCD组比较,PTCD组手平均术时间(119.5 min vs.136.6 min)、术中出血量(44.70 mL vs.62.81 mL)、术后排气时间(9.52 h vs.11.13 h)、住院时间(11.85 d vs.13.53 d)、住院费用(1.28万元vs.1.44万元)均明显减少(均P0.05),两组术后直接胆红素术水平均较术前下降,但两组间手术前后直接胆红素术水平差异均无统计学意义(均P0.05),PTCD组与非PTCD组术后并发症发生率无统计学差异(3.0%vs.15.6%,P=0.087)。结论:胆囊结石伴胆总管结石患者行胆道探查术后一期缝合时,术前经超声检查胆总管直径≥1.0 cm,即使没有严重肝功能损伤,亦可置入PTCD,有利于肝功能恢复、降低平均住院时间及费用。