胆道探查术中胆道镜辅助选择胆管一期缝合的应用价值

目的比较胆道探查术后胆管一期缝合与T管引流两种治疗方法的胆道压力及肝脏代谢的变化。方法选取适合患者40例，分为一期缝合组与T管引流组，比较两组患者术后第1、3、7天胆道压力和阻力、血中总胆汁酸、直接胆红素、GGT、ALP的情况。结果一期缝合组与T管引流组在胆道压力、胆道阻力、血中总胆汁酸、直接胆红素、GGT、ALP的差异无统计学意义（尸〉0．05），缝合组术后l例发生胆漏，经引流后治愈。一期缝合组在手术时间、并发症、疼痛评分、住院时间及治疗费用等方面具有优势。结论对于合适的患者，胆道探查术后胆管一期缝合避免了放置T管引起的一系列弊端，是安全可行的。

The value of primary duct closure in cholangioscopy choledochotomy

Objective To compare the therapeutic effect of primary duct closure and T-tube drainage in cholan- gioscopy choledoehotomy for bile duct stones. Methods Forty patients with bile duct stones were divided into two groups （primary duct closure group and T-tube drainage group） for comparing biliary pressure, biliary resistance, the to- tal bile acid, direct bilirubin, GGT and ALP. Results There were no significant difference in biliary pressure, biliary resistance, the total bile acid, direct bilirubin, GGT, ALP between the two groups （P 〉 0.05）. The bile of patients in pri- mary duct closure group leaked out and cured by drainage. The incidence of the operating time, the complication of operation, Visual Analogue Scale （VAS） scores for pain severity, postoperative hospital stay and sugery-related cost in pri- mary duct closure group was dramatically decreased as compared with T-tube drainage group （P 〈 0.01）. Conclusion Pri- mary duct closure in cholangioseopy choledochotomy can avoid the deficiency of T-tube drainage. It has obvious ad- vantage, and it is feasible and safe in treating bile duct stones.