摘要
目的比较腹腔镜下胆囊切除术联合胆总管探查术后胆总管一期缝合与T管引流的临床疗效,以期为临床探索出更加合理的诊疗方案。方法回顾性分析西安市第九医院联合西安交大第一附属医院于2014年1月至2019年1月期间收治的108例胆总管结石患者的临床资料,所有患者均接受腹腔镜下胆囊切除术联合胆总管探查术治疗,其中50例接受胆总管一期缝合治疗者纳入观察组,58例行T管引流者则纳入对照组。比较两组患者的手术时间、术中出血量、术后肛门首次排气时间、腹腔引流时间、住院花费及胆汁漏发生率。对患者进行为期18个月的随访,比较两组患者的结石复发率。结果两组患者在术中出血量、术后首次排气时间、腹腔引流时间等方面比较差异均无统计学意义(P>0.05);观察组患者的手术时间、术后住院时间、住院费用分别为(83.32±12.48) min、(7.56±1.07) d、(18 340.2±2 418.7)元,明显少于对照组的(91.56±13.02) min、(8.95±1.76) d、(22 135.5±2 332.5)元,差异均有统计学意义(P<0.05);观察组患者术后胆汁漏发生率为4.00%,与对照组的1.72%比较差异无统计学意义(P>0.05);随访18个月,观察组患者的结石复发率为2.00%,与对照组的5.17%比较,差异无统计学意义(P>0.05)。结论腹腔镜下胆囊切除术联合胆总管探查术后胆总管一期缝合与T管引流比较,具有手术时间及住院时间短,术后肠功能恢复快,住院费用低的优势。
Objective To compare the clinical efficacy of primary suture of common bile duct and T-tube drainage after laparoscopic cholecystectomy combined with common bile duct exploration,so as to explore a more reasonable treatment plan for clinical practice.Methods The clinical data of 108 patients with choledocholithiasis,who admitted to Xi'an Ninth Hospital(the First Affiliated Hospital of Xi'an Jiaotong University)from January 2014 to January 2019,were retrospectively analyzed.All patients received laparoscopic cholecystectomy combined with common bile duct exploration.Among of them,50 patients who received primary suture of common bile duct were included into the observation group,and 58 patients with T-tube drainage were included into the control group.The operation time,intraoperative blood loss,postoperative anal exhaust time,abdominal drainage time,hospitalization expenses and bile leakage rate were recorded.The patients were followed up for 18 months to compare the recurrence rate of stones.Results There was no significant difference between the observation group and the control group in intraoperative blood loss,postoperative first exhaust time,abdominal drainage time(all P>0.05);the operation time,postoperative hospital stay,and hospitalization expenses of the observation group were(83.32±12.48)min,(7.56±1.07)d,(18340.2±2418.7)yuan,respectively,which were significantly less than corresponding(91.56±13.02)min,(8.95±1.76)d,(22135.5±2332.5)yuan of the control group(all P<0.05).The incidence of postoperative bile leakage in the observation group was 4.00%,compared with 1.72%in the control group(P>0.05);the recurrence rate of calculus in the observation group was 2.00%,compared with 5.17%in the control group(P>0.05).Conclusion Compared with T-tube drainage,primary suture of common bile duct after laparoscopic cholecystectomy combined with common bile duct exploration has the advantages of shorter operation time,shorter hospitalization time and lower hospitalization cost.
作者
黄悦
刘学民
祁亚斌
雷凯
HUANG Yue;LIU Xue-min;QI Ya-bin;LEI Kai(Second Department of General Surgery,Xi'an Ninth Hospital,Xi'an 710054,Shaanxi,CHINA;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第23期3071-3073,共3页
Hainan Medical Journal
关键词
胆总管结石
胆囊结石
腹腔镜下胆总管探查术
胆囊切除
一期缝合
T管引流
疗效
Choledocholithiasis
Cholecystolithiasis
Laparoscopic common bile duct exploration
Cholecystectomy
Primary suture
T tube drainage
Curative effect
