胆总管探查后一期缝合术与T管引流术的临床研究

目的观察胆总管探查后一期缝合术与T管引流术的临床疗效,探讨胆总管探查后一期缝合术的适应证。方法分析136例行开腹胆总管探查手术患者的临床资料,按照随机数字表法分为两组,其中46例行胆总管一期缝合术(观察组),90例行T管引流术(对照组),对比两组术中及术后恢复情况,从而探讨胆总管探查后一期缝合术的适应证。结果所有患者手术均一次成功,两组患者在手术时间(P=0.904)、术中出血量(P=0.476)、腹腔引流量(P=0.198)、胆漏发生率(P=0.705)、切口感染率(P=0.874)、术后残留结石率(P=1.000)差异无统计学意义;观察组在术后首次肛门排气时间(P0.001)、术后禁食时间(P0.001)、术后补液量(P0.001)、术后住院时间(P0.001)均明显低于对照组。结论在严格掌握好手术适应证及手术操作要领的情况下,胆总管探查后一期缝合术是安全、有效的,适于在临床推广。

The clinical research on choledochus primary suture and T-tube drainage after exploration of common bile duct stones

Objective Observe the clinical effects of choledochus primary suture and T- tube drainage after exploration of common bile duct stones and discuss the indications of choledochus primary suture after exploration of common bile duct stones. Meth- ods Analysis of the clinical data of 136 patients who were treated at the exploration of common bile duct stones, patients had been di- vided into two groups according to random number table method, 46 patients in the first group had been treated at choledochus primary suture（ observation group） and 90 patients in the second group had been treated at T-tube drainage（ control group）. Observe the recov- ery of two groups to discuss the indications of choledoehus primary suture after exploration of common bile duct stones. Results All operations were successful. There was no statistically significant difference between two groups in operation time （P = 0. 904）, peri-op- eration bleeding（ P = 0. 476 ） , abdominal drainage fluid（ P = 0. 198 ）, the rate of bile leakage（ P = 0. 705 ）, the infection rate of surgi- cal incision（0. 874 ） and the rate of postoperative stone （P = 1. 000）. The observation group is obviously lower than the control group on the first time of anus exhaust（ P 〈 0. 001 ）, the time of postoperative fasting（ P 〈 0. 001 ）, the volume of postoperative rehydratiou fluids （ P 〈 0. 001 ） and the time of postoperative stay. Conclusion With the definite indication and proficient surgical technology, the primary suture after exploration of common bile duct stones is a safe and effective way to treat common bile duct stones. It is valuable to widely popularize in clinical practice.