腹腔镜胆总管探查一期缝合与T管引流的比较

目的总结腹腔镜胆总管探查一期缝合和T管引流的临床疗效。方法回顾性分析腹腔镜胆总管探查一期缝合（primary suture,PS）组21例和T管引流（t-tube drainage,TD）组40例患者的临床资料。结果PS组的手术时间、术中出血量分别为（105.5±15.7）min和（53.1±21.4）ml,术后无胆漏或胆管残余结石发生;而TD组的手术时间、术中出血量分别为（112.4±18.4）min和（63.5±22.0）ml,术后发生胆漏2例,胆管残石3例,两组比较无差异（P〉0.05）,而在术后下床活动时间、胃肠道功能恢复时间及住院时间上PS组为（26.3±6.1）h、（24.6±2.6）h、（5.7±1.0）d,明显短于TD组的（38.7±10.0）h、（33.1±8.8）h、（9.0±1.8）d,P〈0.05。结论在严格掌握手术适应证的情况下,一期缝合术较T管引流术更能体现腹腔镜技术的优越性。

Comparison between Primary Closure and T-tube Drainage of Common Bile Duct after Laparoscopic Exploration

Objective To compare the clinical effect between primary closure and T-tube drainage after laparoscopic common bile duct exploration.Method Retrospective analysis was used to the data of 21 cases underwent primary suture（PS group）and 40 cases underwent T-tube drainage（TD group） after laparoscopic common bile exploration.Results There was no significant difference between the PS group and TD group in items of operation time,blood loss,bile leakage rate and remnant stone rate after operation,which was（105.5±15.7）minutes vs（112.4±18.4）minutes,（53.1±21.4）ml vs（63.5±22.0）ml,0 vs 5%,and 0 vs 7.5%（P〉0.05）.But the out-of-bed time,gastrointestinal recovery time and postoperative hospital stay were（26.3±6.1）hours,（24.6±2.6）hours,and（5.7±1.0）days in PS group,which was shorter than those of（38.7±10.0）hours,（33.1±8.8）hours,and（9.0±1.8）days in TD group（P〈0.05）.Conclusion In the condition of strict controlling the indications,primary closure after laparoscopic common bile duct exploration is more better to embody the superiority of laparoscopic technology than T-tube drainage.