腹腔镜下胆总管切开取石后一期缝合与T管引流的临床疗效比较

发布时间：2018-03-24 22:08

本文选题：胆总管结石　切入点：腹腔镜胆总管切开取石　出处：《吉林大学》2017年硕士论文

【摘要】：目的:探讨腹腔镜胆总管切开取石后一期缝合和T管引流的临床疗效及一期缝合的可行性。方法:回顾性分析2014年12月-2016年12月施行的71例腹腔镜胆总管切开取石术患者临床的资料,其中一期缝合33例(PS组),T管引流38例(TD组)。结果:两组患者在人口学特征及ASA分级方面差异无统计学意义。一期缝合组(PS)和T管引流组(TD)胆总管平均直径11.6±2.4mm、11.4±2.1mm,结石数量2.3±1.1枚、2.3±0.9枚,术前总胆红素47.3±42.7μmol/L、56.4±52.4μmol/L,P0.05,两组间差异无统计学意义。一期缝合组(PS)和T管引流组(TD)手术时间分别为112.3±27.6min、131.1±22.6min,排气时间分别为2.4±0.6天、3.0±0.8天,术后住院时间5.1±1.6天、5.9±1.8天,P值均小于0.05,两组间存在统计学差异。一期缝合组与T管引流组术后腹腔引流时间分别为4.0±1.6天、4.5±1.4天,P0.05,两组差异无统计学意义。一期缝合组3例患者术后出现少量胆瘘,延长腹腔引流时间后胆瘘自愈。1例患者出现切口感染。T管引流组2例患者术后出现少量胆瘘。1例患者术后5周出现T管意外脱落,1例患者术后出现急性胰腺炎。两组并未出现严重术后并发症,P0.05两组术后并发症比较差异无统计学意义。结论:与T管引流相比,腹腔镜胆总管探查术后一期缝合手术时间、排气时间、术后住院时间明显减少。严格掌握一期缝合的手术适应症的情况下,精细操作,并不会增加术后胆瘘,残余结石及胆管狭窄等并发症的发生率,是安全有效的。
[Abstract]:Objective: to investigate the clinical effect of primary suture and T tube drainage after laparoscopic choledocholithotomy and the feasibility of primary suture. Methods: 71 cases of laparoscopic choledocholithotomy from December 2014 to December 2016 were retrospectively analyzed. Clinical data of patients undergoing lithotomy, Results: there was no significant difference in demographic characteristics and ASA grading between the two groups. The mean diameter of common bile duct in primary suture group and T tube drainage group was 11.6 卤2.4 卤2.1 mm, and the number of stones was 2.3 卤1.1, 2.3 卤0.9, respectively. The total bilirubin before operation was 47.3 卤42.7 渭 mol / L, 56.4 卤52.4 渭 mol / L, there was no significant difference between the two groups. The operative time of primary suture group and T-tube drainage group were 112.3 卤27.6min, 131.1 卤22.6min and 2.4 卤0.6 days, respectively. The postoperative hospitalization time of 5.1 卤1.6 days and 5.9 卤1.8 days was less than 0.05, and there was statistical difference between the two groups. The postoperative celiac drainage time of primary suture group and T-tube drainage group was 4.0 卤1.6 days and 4.5 卤1.4 days, respectively (P 0.05). There was no significant difference between the two groups. A small amount of biliary fistula occurred in 3 patients after operation. After prolonging the time of celiac drainage, 1 case of biliary fistula healed by incision infection and 2 cases of T tube drainage group showed a small amount of biliary fistula after operation. 1 case of acute pancreatitis occurred 5 weeks after operation. There was no significant difference in postoperative complications between the two groups (P0.05). Conclusion: compared with T-tube drainage, there is no significant difference in postoperative complications between the two groups. Laparoscopic choledochus exploration after primary suture operation time, exhaust time, postoperative hospital stay significantly reduced. Strict grasp of the operation indications of primary suture, fine operation, will not increase postoperative biliary fistula, The incidence of complications such as residual stones and bile duct stenosis is safe and effective.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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