老年胆总管结石合并2型糖尿病患者腹腔镜胆总管探查术胆总管一期缝合与T管引流的疗效比较

目的比较腹腔镜胆总管切开探查术(LCBDE)胆总管一期缝合和T管引流治疗老年胆总管结石合并2型糖尿病(T2DM)患者的疗效。方法腹腔镜下胆总管切开探查+纤维胆道镜取石治疗老年胆总管结石合并T2DM患者65例,其中术后采用胆总管一期缝合33例为A组,采用T管引流术32例为B组。比较两组手术时间、术中出血量、术后住院时间、补液量、住院费用及并发症发生率。结果与B组比较,A组手术时间短、术后住院时间短、补液量少、住院费用少、发热时间短,两组比较差异均有统计学意义(t分别=2.13、2.61、3.78、3.29、3.02,P均<0.05);A组并发胆漏、胆管狭窄、腹腔感染、结石残余和胆管炎的发生率与B组比较,差异均无统计学意义(χ2分别=3.58、2.61、4.27、3.88、3.51,P均>0.05)。结论与术后采用T管引流术比较,胆总管探查术后一期缝合对于老年胆总管结石合并T2DM患者是安全可靠的。

Comparison between primary duct closure and T-tube drainage in laparoscopic common bile duct exploration in elderly patients with common bile duct stones and T2DM

Objective To compare the therapeutic effect of primary duct closure and T-tube drainage in laparoscopic common bile duct exploration in elderly patients common bile duct stones and T2DM. Methods Sixty five cases of elderly patients with common bile duct stones and with T2DM were undergone laparoscopic choledochotomy. The patients were divided into two groups： primary duct closure group（group A） and T-tube drainage group （group B）. The operation time ,blood loss, postoperative hospital stay,postoperative transfusion, hospital costs and the rate of complications occurring were compared.Results Compared with group B, group A had shorter operation time and postoperative hospital stay, less postoperative transfusion and hospital costs, shorter time of fever duration. The differences were statistically significant （t=2.13, 2.61, 3.78, 3.29, 3.02,P〈0.05）. There were no significant differences in the rate of complications occurring between two groups （X^2=-3.58, 2.61, 4.27, 3.88, 3.51 ,P〉0.05）. Conclusions Compared with T-tube drainage, primary duct closure in laparo- scopic choledochotomy is more safe and reliable for elderly common bile duct stones combined with T2DM patients.