摘要
目的:探讨腹腔镜下胆总管探查一期缝合术治疗胆总管结石的可行性、有效性及安全性。方法:回顾性分析我院2015-03~2020-05收治的528例胆总管结石患者的临床资料。所有患者均行腹腔镜下胆总管探查取石术,其中167例行胆总管一期缝合术(primary duct closure,PDC)闭合胆管(PDC组),361例行T管引流术(T-tube drainage,TTD)闭合胆管(TTD组)。比较两组手术时间、术后住院时间等相关临床指标及术后并发症发生情况。结果:PDC组与TTD组的手术时间分别为(65.9±18.2)min、(90.9±26.2)min,术后住院时间分别为(2.6±1.7)d、(4.2±1.9)d,差异有统计学意义(P<0.05)。术中出血量、引流管放置时间、胃肠功能恢复时间比较,差异无统计学意义(P>0.05)。两组均无严重并发症发生,PDC组18例术后发生胆漏,发生率为10.8%,TTD组13例发生胆漏,发生率为3.6%,差异有统计学意义(P<0.05)。结论:腹腔镜下胆总管探查一期缝合术虽术后出现胆漏,但经过短期单纯引流可痊愈,且PDC较TTD更为可行、有效、安全,能明显提高患者术后生活质量,对于有适应证的患者,可作为胆总管结石治疗的首选方法。
Objective:To investigate the feasibility,efficacy and safety of laparoscopic primary duct closure for bile duct exploration in treatment of choledocholithiasis.Methods:A total of 528 patients with choledocholithiasis from March 2015 to May 2020 in our hospital were retrospectively analyzed.All patients underwent laparoscopic common bile duct exploration(LCBDE),167 patients underwent primary duct closure(PDC)after LCBDE were selected as PDC group,and 361 patients underwent T-tube drainage(TTD)after LCBDE were selected as TTD group.The relevant clinical indicators and occurrence of complication between the two groups were compared.Results:The operation time between PDC group and TTD group was(65.9±18.2)min and(90.9±26.2)min,respectively,and the length of postoperative hospitalization was(2.6±1.7)d and(4.2±1.9)d,respectively,the differences were statistically significant(P<0.05).There were no statistically significant differences in intraoperative blood loss,drainage tube placement time and gastrointestinal function recovery time(P>0.05).Two groups had no serious complications occurred,there were 18 patients of postoperative bile leakage in PDC group,the incidence rate was 10.8%,and there were 13 patients of postoperative bile leakage in TTD group,the incidence rate was 3.6%,the differences were statistically significant(P<0.05).Conclusion:Although LCBDE+PDC may be increased the incidence of bile leakage,it can be cured after short-term simple drainage,and PDC is more feasible,effective and safe than TTD,which can significantly improve the quality of life in patients after operation.For patients with indications,it can be the first choice for the treatment of common bile duct stones.
作者
上官建营
秦建伟
范瑞芳
李月胜
付振东
党政
肖毅
魏雪
SHANGGUAN Jianying;QIN Jianwei;FAN Ruifang;LI Yuesheng;FU Zhendong;DANG Zheng;XIAO Yi;WEI Xue(Department of General Surgery,the 940th Hospital of Joint Logistic Support Force of PLA, Lanzhou 730050,China)
出处
《西北国防医学杂志》
CAS
2020年第11期686-690,共5页
Medical Journal of National Defending Forces in Northwest China
关键词
胆总管结石
腹腔镜下胆总管探查取石术
一期缝合术
choledocholithiasis
laparoscopic common bile duct exploration
primary duct closure
