摘要
目的探讨比较腹腔镜下胆总管切开一期缝合与放置T管引流对手术操作及术后并发症的影响。方法选取2016年10月~2018年9月两年时间我院诊断为胆总管结石并行LCBD的106例患者进行回顾性分析,其中患者男女比例为57∶49,年龄范围为29~62岁,平均(46.32±5.92)岁。所选入的106例患者中有43例行一期缝合,称为一期组;63例行传统的T管引流,为T管组。分析比较患者围手术期情况、术后并发症及预后情况等指标。结果两组患者在术前指标、手术用时、术中出血、腹腔引流量和术后通气时间等指标无明显差异,而肠胃恢复时间、胆管炎、腹泻、术后并发症总发生率、术后住院时间和治疗总花费六项指标中,一期缝合组指标分别为(2.7±0.44)d、(0,0%)、(1,2.3%)、7(16.2%)、(4.9±1.60)d、(1.48±0.362)万元都比T管组(5.6±1.49)d、(6,9.5%)、(8,12.7%)、23(36.5%)、(7.3±2.24)d、(1.80±0.263)万元有统计学差异(t=3.621、χ^2=7.492、χ^2=8.271、χ^2=6.952、t=4.783、t=5.911P<0.05)。结论腹腔镜胆总管切开一期缝合在围手术期并发症、术后恢复和医疗花费较T管引流有明显优势,对于腹腔镜操作技术过关的医师来说,如患者病情无明显禁忌推荐一期缝合。
Objective To compare the effects of laparoscopic primary suture and t-tube drainage on surgical operation and postoperative complications.Methods A retrospective analysis was performed on 106 patients diagnosed with choledocholithiasis and LCBD in our hospital from October 2016 to September 2018.The male to female ratio was 57 ∶ 49,and the age range was 29 - 62 years,with an average age of (46.32 ± 5.92) years.Forty-three of the 106 patients were treated with primary suture,which was called the primary suture group.A total of 63 patients underwent traditional t-tube drainage.The perioperative period,postoperative complications and prognosis of the patients were analyzed and compared.Result Comparing primary suture group and T-tube group,there were no significant differences between in preoperative parameters,operation time,intraoperative bleeding,peritoneal drainage and postoperative breaking wind (P > 0.05).However,in gastrointestinal recovery time (2.7 ± 1.44)d vs (5.6 ± 1.9)d (t = 3.621,P < 0.05),incidence of cholangitis 0%(0 /43) vs 9.5%(6 /63)(χ^2 = 7.492,P < 0.05),diarrhea 2.3%(1 /43) vs 12.7%(8 /63)(χ^2 = 8.271,P < 0.05),total complication 16.2%(7 /43) vs 36.5%(23 /63)(χ^2 = 6.952,P < 0.05),hospital stay (4.9 ± 1.60)d vs (7.3 ± 2.24)d (t = 4.783,P < 0.05),and total cost ￥(1.48 ± 0.362) ten thousand vs ￥(1.80 ± 0.263) ten thousand (t = 5.911,P < 0.05),the differences had statistically significant.Conclusion The primary suture of laparoscopic choledochotomy has obvious advantages over t-tube drainage in perioperative complications,postoperative recovery and medical costs.For physicians who have passed the laparoscopic surgery,the primary suture is recommended if the patient's condition is not obviously contraindicated.
作者
王学国
黎东明
吴雷
陆路
宋文渊
WANG Xue-guo;NI Dongming;WU Lei(The Second Hospital of Hainan Medical College,Hainan 570311,China)
出处
《肝胆外科杂志》
2019年第3期194-197,共4页
Journal of Hepatobiliary Surgery
关键词
腹腔镜胆总管切开取石
胆管结石
一期缝合
T管引流
围手术期
对比研究
Laparoscopic choledocholithotomy
Bile duct stones
First phase of the suture
T tube drainage
perioperative
The comparative study
