腹腔镜下胆总管切开取石术中一期缝合与T管引流治疗效果对比

目的比较腹腔镜下胆总管切开取石术中一期缝合与T管引流治疗胆总管结石的效果,并探讨术中一期缝合胆总管的可行性。方法回顾性分析2014年1月至2016年6月江苏大学附属武进医院南院普外科行腹腔镜手术治疗胆总管结石患者的临床资料,选择符合纳入标准的患者共71例,分为一期缝合组(n=33)和T管引流组(n=38)两组,比较两组患者手术时间、术中出血量、术后住院天数及住院费用、术后并发症发生率等指标。结果一期缝合组与T管引流组在术后Na~+水平(138.76±2.57)mmol/L vs(134.99±3.15)mmol/L,P0.05]、术后胃肠道恢复时间(2.33±0.66)d vs(3.15±0.88)d,P0.05]、住院时间(8.38±3.20)d vs(10.80±1.44)d,P0.05]以及住院费用(1.87±0.46)×10~4元vs(2.27±0.68)×10~4元,P0.05]等方面均具有统计学差异;两组术后各发生3例胆漏(P=0.857),未发生胆道残余结石、胆道狭窄等并发症。结论在充分掌握手术适应证的前提下,腹腔镜胆总管切开取石术中行胆总管一期缝合安全可靠;较T管引流而言,该方式具有减少电解质流失、加速患者康复、缩短住院时间及减轻费用负担等优势,值得在临床进一步推广应用。

Analysis of therapeutic effects between primary duct closure and T-tube drainage after laparoscopic common bile duct exploration

Objective To compare the clinical efficacy between primary duct closure and T-tube drainage after laparoscopic common bile duct exploration, and to discuss the feasibility of primary duct closure. Methods Retrospective analysis was performed on 71 patients who admitted in the Changzhou Wujin People's Hospital from Jan. 2014 to Jun. 2016. Patients were divided into primary duct closure group (n=33) and T-tube drainage group (n=38). Operation duration, intra-operative blood loss, postoperative hospitalization duration, hospitaliza-tion expense and rate of postoperative complications between two groups were compared. Results The level of Na+ after surgery (138.76±2.57) mmol/L vs (134.99±3.15) mmol/L, P<0.05], postoperative gastrointestinal recovery time (2.33±0.66) d vs (3.15±0.88) d, P<0.05], postoperative hospitalization duration (8.38±3.20) d vs (10.80±1.44) d, P<0.05] and hospitalization expense (1.87±0.46)×104 RMB vs (2.27±0.68)×104 RMB, P<0.05] showed significant differences between primary duct closure group and T-tube drainage group; 3 cases of bile leakage occurred in each group (P=0.857), no residual stones or biliary stricture was found in either group. Con-clusion With appropriate indications, primary duct closure after laparoscopic common bile duct exploration is safe and reliable, which can reduce the loss of electrolyte, enhance the recovery of patients, shorten postoperative hospital stay and lighten up economic burdens, it is worth to be applied in clinic.