摘要
目的比较胆总管结石患者行胆总管一期缝合及T管引流术的疗效,并探讨胆总管一期缝合术后胆漏的危险因素。方法回顾性分析2010年1月至2016年8月安徽省阜南县人民医院收治并完成胆总管探查术的183例患者临床资料,其中胆总管一期缝合(观察组)82例,T管引流(对照组)101例,分析比较两组的治疗效果,并对胆总管一期缝合术后胆漏发生的相关因素进行单因素分析和Logistic回归多因素分析。结果两组均顺利完成手术,围手术期无死亡病例。两组手术时间、术中出血量、腹腔引流管留置时间比较,差异均无统计学意义(P>0.05);而在术后肛门首次排气时间、术后住院时间上,两组差异有统计学意义(P<0.05)。实施胆总管一期缝合术的82例患者中,8例发生术后胆漏(9.76%),单因素分析结果显示:胆道手术史、术前血白蛋白水平、术前总胆红素与一期缝合术后胆漏有关(P<0.05);多因素分析结果表明:术前胆红素水平以及术前血清白蛋白水平是影响胆总管一期吻合术后胆漏的独立危险因素(P<0.05)。结论胆总管一期缝合术的临床疗效优于T管引流术;胆总管一期缝合术后胆漏受多种因素影响。为减少术后胆漏的发生,术者需具备熟练的手术缝合技术(包括腔镜缝合技术)。需开展大样本、多中心的前瞻性随机对照研究来进一步明确胆总管切开后一期吻合和T管留置的手术适应证。
Objective To compare the therapeutic effects of primary suture and T-tube drainage after surgicalexploration on the patients with common bile duct stones,and to investigate the risk factors of bile leakage after primary suture of common bile duct.Methods The clinical data of183patients who underwent common bile duct exploration in Funan People’s Hospital between Jan.2010and Aug.2016were analyzed retrospectively.Of which,82cases underwent primary suture of common bile duct(suture group),while101cases received T-tube drainage of common bile duct(drainage group).The treatment effects of two groups were compared and analyzed.And the risk factors of biliary leakage in suture group were analyzed by univariate and multivariate logistic regression.Results The surgical procedures were successfully performed in all patients.No death was found during the perioperative period.There was no significant difference between the two groups in operation time,intraoperative blood loss,abdominal drainage tube indwelling time(P>0.05);but there were significant differences in the time to passage of first flatus after operation and the postoperative hospital duration between two groups(P<0.05).Eight cases was found with postoperative biliary fistula in the primary suture group(9.76%).Univariate analysis showed that the history of biliary tract surgery,preoperative serum albumin level were related to the occurrence of bile leakage after primary suture(P<0.05).And the multivariate analysis showed that preoperative bilirubin level and serum albumin level were the independent risk factors of bile leakage after primary suture(P<0.05).Conclusion Effect of primary suture after exploration for the patients with common bile duct stones was better than that that of T-tube drainage.For the reduction of postoperative biliary leakage,sophisticated suture skilling is needed.Large,multicenter prospective randomized controlled trials is needed for further clarifythe surgical indications of the primary suture and T-tube drainage after the common bile
作者
刘学礼
吴卫国
张玉豹
赵炳奎
李京
LIU Xue-li;WU Wei-guo;ZHANG Yu-bao;ZHAO Bing-kui;LI Jing(Department of General Surgery, Funan People’s Hospital, Fuyang, Anhui 236300, China)
出处
《肝胆胰外科杂志》
CAS
2017年第3期196-199,202,共5页
Journal of Hepatopancreatobiliary Surgery
关键词
胆总管结石
一期缝合
T管引流
胆漏
危险因素
common bile duct stones
primary suture
T-tube drainage
bile leakage
rsk factors
