胆总管探查内置自行脱落J管一期缝合与T管引流治疗胆总管结石的临床分析

目的 比较腹腔镜胆总管探查放置自行脱落J管一期缝合与T管引流的临床疗效，探讨胆总管一期缝合放置自行脱落J管引流的可行性。方法 回顾性分析2019年3月至2020年10月西安交通大学附属咸阳市中心医院肝胆外科156例行腹腔镜下胆囊切除联合胆总管探查患者的临床资料。按手术方式分为自行脱落J管组（n=80）和T管引流组（n=76），比较两组患者基线资料、术中术后情况及并发症等。结果 两组手术总时间、术中出血量、术后并发症情况无统计学差异（P＞0.05）。自行脱落J管组较T管引流组术后下床活动时间（18.2±7.2）h vs（22.1±8.3）h，t=3.139，P=0.002]、术后排气时间（1.7±0.9）d vs（2.1±1.3）d，t=2.244，P=0.026]、补液总量（5 634.1±432.8）mL vs（6 351.4±547.9）mL，t=13.56，P＜0.001]、拔管时间（8.7±3.3）d vs（47.1±13.0）d，t=14.966，P＜0.001]、住院时间（7.9±2.8）d vs（9.4±3.3）d，t=3.067，P=0.003]、住院总费用（15 489.2±2 217.1）元 vs（18 136.4±2 251.3）元，t=7.398，P＜0.001]差异有统计学意义。结论 严格掌握手术适应证前提下，自行脱落J管引流扩大了胆总管一期缝合适应证，安全有效，相比T管引流具有加速康复、减少住院费用、缩短住院时间等优势。

Clinical research of self-releasing J tube and T tube drainage in the treatment of choledocholithiasis

Objective To compare the clinical efficacy of primary suture of self-shedding J tube and T tube drainage in laparoscopic common bile duct exploration, and to explore the feasibility of primary suture and self-shedding J tube drainage. Methods Clinical data of 156 patients underwent laparoscopic cholecystectomy combined with common bile duct exploration in the Department of Hepatobiliary Surgery, Xianyang Central Hospital Affiliated to Xi’an Jiaotong University from Mar. 2019 to Oct. 2020 were retrospectively analyzed. According to the surgical method, 156 patients were divided into the self-detachment J tube group (n=80) and the T tube drainage group (n=76). Data of baseline, intraoperative and postoperative conditions between the two groups were compared. Results There were no significant differences in total operative time, intraoperative blood loss and postoperative complications between the two groups. There were statistcal significant differences between self-abscission J tube group and T tube drainage group in postoperative activity time (18.2±7.2)h vs(22.1±8.3)h, t=3.139, P=0.002], exhaust time (1.7±0.9)d vs (2.1±1.3)d, t=2.244, P=0.026], total volume of fluid infusion (5 634.1±432.8)mL vs (6 351.4±547.9)mL, t=13.56, P<0.001], extubation time (8.7±3.3)d vs (47.1±13.0)d, t=14.966, P<0.001], hospitalization time (7.9±2.8)d vs (9.4±3.3)d, t=3.067, P=0.003] and total hospitalization cost (15 489.2±2 217.1)yuan vs (18 136.4±2 251.3)yuan, t=7.398, P<0.001]. Conclusion Under the premise of strictly mastering the surgical indications, the self-shedding J tube drainage expands the indications for primary suture of the common bile duct, which is safe and effective. Compared with T tube drainage, J tube drainage has the advantages in accelerating rehabilitation, reducing hospitalization cost and shortening hospitalization time.