老年患者腹腔镜胆总管探查一期缝合与T管引流的临床疗效分析

目的:比较老年胆囊结石合并胆总管结石患者行腹腔镜胆总管探查一期缝合与T管引流术的临床疗效,总结临床经验。方法:回顾分析2012年8月至2016年8月为115例胆囊结石合并胆总管结石老年患者(≥65岁)行腹腔镜联合胆道镜胆总管探查的手术资料与随访资料,其中一期缝合63例(缝合组),T管引流52例(T管组)。结果:115例手术均顺利完成,无一例中转开腹。两组术中出血量、引流管拔除时间、残余结石发生率差异均无统计学意义(P>0.05),缝合组手术时间、术后镇痛药物使用率、术后住院时间低于T管组(P<0.05),但术后胆漏发生率高于T管组(P<0.05)。结论:与T管引流相比,腹腔镜一期缝合治疗老年胆总管结石患者具有更好的临床疗效。在严格把握手术适应证、确保结石取净、镜下精细缝合的前提下,可作为老年胆总管结石患者优先选择的术式。

Comparative analysis of primary closure versus T-tube drainage following laparoscopic common bile duct exploration in treat-ment of choledocholithiasis in elderly patient s

Objective:To compare the clinical efficacy between primary closure and T-tube drainage following laparoscopic common bile duct exploration ( LCBDE) ,and summarize the clinical experience of these two procedures in treatment of choledocholithi -asis in elderly patients .Methods:The clinical data of 115 elderly patients (≥65 years) with choledocholithiasis and cholecystolithiasis who underwent LCBDE from Aug .2012 to Aug.2016 were retrospectively analyzed ,63 patients received primary closure ( primary clo-sure group) and 52 patients received T-tube drainage of the common bile duct following LCBDE (T-tube group).Results:LCBDE was successfully performed in all the 115 patients without conversion to open surgery .There were no significant differences between two groups in blood loss,abdominal drainage time and incidence of residual calculi (P>0.05).Compared with the T-tube group,the opera-tive time,analgesic drug usage and postoperative hospital stay were significantly less but the incidence of bile leakage was significantly higher in the primary closure group (P<0.05).Conclusions:Primary closure following LCBDE for management of choledocholithiasis in elderly patients has better clinical efficacy than T-tube drainage .Under the premise of strict surgical indications ,ensuring no residual calculi and accurate endoscopic suture techniques ,primary closure following LCBDE can be a preferable surgical procedure in treatment of choledocholithiasis in elderly patients .