腹腔镜胆总管探查一期缝合与T管引流的临床比较分析

发布时间：2018-03-02 03:31

本文关键词： 腹腔镜一期缝合 T管引流胆总管结石胆囊结石　出处：《延安大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较分析腹腔镜胆总管探查一期缝合胆总管与腹腔镜胆总管探查T管引流的临床疗效,探讨腹腔镜胆囊切除并胆总管探查后一期缝合胆总管治疗胆囊结石合并胆总管结石的可行性、安全性及应用价值。方法:依据入选标准对我院(延安大学附属医院)自2014年10月至2016年12月诊断为胆囊结石合并胆总管结石行腹腔镜下胆囊切除并胆总管探查术的58例患者临床资料进行回顾性分析。根据腹腔镜胆总管探查术后胆总管一期缝合还是T管引流分为两组:一期缝合组(PS组)25例、T管引流组(TD组)33例,分别比较两组之间的手术时间、术中出血量、术后腹腔引流量、术后输液量、术后首次肛门排气时间、术后住院天数、住院费用及术后并发症发生情况。结果:两组患者术后均未出现死亡病例。PS组vs TD组:在术中出血量(ml)(41.00±17.80 vs 39.00±14.06 P=0.634)、术后腹腔引流量(ml)[34.00(14.00~41.50)vs 20.00(17.00~32.00)P=0.352]等方面,两组之间差异无统计学意义;然而在手术时间(min)(130.44±12.07 vs 165.00±22.81 P=0.000)、术后输液量(ml)(10771.60±1666.84 vs 12462.06±877.35 P=0.000]、肛门首次排气时间(h)[42.00(38.00~45.50)vs 44.00(43.50~46.00)P=0.001]、术后住院时间(d)[7.00(6.00~8.00)vs 8.00(7.00~8.50)P=0.010]、住院费用(元)(21374.12±1003.08 vs 22756.18±1327.83 P=0.000)等方面,PS组均明显优于TD组,两组之间差异有统计学意义;在术后并发症方面:PS组术后出现1例轻微胆漏;TD组出现1例轻微胆漏,1例胆总管结石残留,1例T管拔除后胆汁性腹膜炎,1例低钾血症,1例代谢性酸中毒综合征,PS组术后并发症发生率与TD组之间差异无统计学意义(P0.05);两组患者术后平均随访13个月(3~24个月),均未见明显的胆道狭窄。结论:腹腔镜胆总管探查一期缝合胆总管较T管引流具有手术时间短、术后输液量少、消化道功能恢复快、术后住院时间短、住院费用低等明显优势,腹腔镜胆总管探查一期缝合胆总管并不增加术后并发症发生率,且获得良好的临床疗效。因此做到术前评估选择合适的病例,术中熟练掌握腹腔镜及胆道镜相关操作技术结合良好的腔镜下缝合打结技术,并掌握腹腔镜胆总管探查一期缝合胆总管的适应症,腹腔镜胆囊切除并胆总管探查后一期缝合胆总管治疗胆囊结石合并胆总管结石的临床疗效是安全、有效、可行的,值得临床开展应用。
[Abstract]:Objective: To compare the clinical efficacy of laparoscopic choledochotomy with primary suture of common bile duct and T tube drainage of laparoscopic common bile duct exploration, to explore the feasibility of laparoscopic cholecystectomy and common bile duct after primary suture of common bile duct in treatment of cholecystolithiasis complicated with choledocholithiasis, safety and clinical value. Methods: according to the inclusion criteria in our hospital (Affiliated Hospital of Yan'an University from October 2014 to December 2016) for the diagnosis of the clinical data of 58 cases of resection of gallbladder and common bile duct stones underwent laparoscopic cholecystectomy and choledochotomy were retrospectively analyzed. According to the laparoscopic common bile duct after common bile duct suture or T tube drainage were divided into two groups: a suture group (PS group) in 25 cases, T tube drainage group (TD group) 33 cases, were compared between the two groups of operation time, bleeding volume, postoperative drainage volume, postoperative infusion volume, postoperative anal exhaust Time, postoperative hospital stay, hospitalization expenses and postoperative complications. Results: two groups of patients were no deaths in the.PS group vs TD group: intraoperative blood loss (ML) (41 + 17.80 vs 39 + 14.06 P=0.634), postoperative abdominal drainage (ML [34.00 (14) ~41.50) vs 20 (17.00~32.00) P=0.352], there was no significant difference between the two groups; however, at the time of surgery (min) (130.44 + 12.07 vs 165 + 22.81 P=0.000), postoperative infusion volume (ML) (10771.60 + 1666.84 vs 12462.06 + 877.35 P=0.000], first anal exhaust time (H ([42.00) 38.00~45.50) vs 44 (43.50~46.00) P=0.001], postoperative hospitalization time (d) [7.00 (6.00~8.00) vs 8 (7.00~8.50) P=0.010], the hospitalization expenses (yuan) (21374.12 + 1003.08 vs 22756.18 + 1327.83 P=0.000) and PS group were significantly better than TD group, there were statistically significant differences between the two groups in complications; after the party Surface: PS group postoperative bile leakage occurred in 1 cases of mild TD group; 1 cases of mild bile leakage, 1 cases of residual common bile duct stones, 1 cases of bile peritonitis after removal of T tube, 1 cases of hypokalemia, 1 cases of metabolic acidosis syndrome PS, postoperative complication rate and the difference between TD group had no statistical significance (P0.05); the average follow-up of the two groups of patients after 13 months (3~24 months), there were no obvious bile duct stenosis. Conclusion: laparoscopic choledochotomy with primary suture of common bile duct with T tube drainage with shorter operation time, less postoperative infusion volume, gastrointestinal function recovery after surgery, shorter hospital stay, hospitalization cost advantages, laparoscopic choledochotomy with primary suture of common bile duct does not increase the incidence of postoperative complications, and obtain good clinical curative effect. So evaluation of selected cases of preoperative, intraoperative skilled laparoscopic and choledochoscopic technique combined with good correlation operation Endoscopic suturing and knotting technique, and master the laparoscopic choledochotomy with primary suture of common bile duct indications, clinical curative effect of laparoscopic cholecystectomy and common bile duct after primary suture of common bile duct in treatment of cholecystolithiasis and choledocholithiasis is safe, effective, feasible, worthy of clinical application.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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