不留置T管引流治疗胆囊结石并胆总管结石的临床疗效

发布时间：2018-04-21 10:06

本文选题：胆囊结石病 + 胆总管结石　；参考：《中国普通外科杂志》2016年08期

【摘要】：目的:探讨不留置T管引流治疗胆囊结石合并胆总管结石的临床疗效。方法:回顾性分析2013年9月—2014年9月收治的100例胆囊结石合并胆总管结石患者的临床资料,其中45例行腹腔镜胆囊切除(LC)+胆总管探查胆道一期缝合术(一期缝合术组),55例行LC+经内镜下十二指肠乳头括约肌切开术(括约肌切开术组);所有患者随访12~24个月。对比分析两组患者的相关临床资料。结果:两组术前年龄、性别、胆红素、转氨酶及胆管结石直径差异均无统计学意义(均P0.05),但一期缝合术组胆总管扩张直径明显大于括约肌切开术组(P0.05)。100例均顺利完成手术、术后痊愈出院。两组患者术后第1天均可下床活动,手术时间、总住院时间、结石残余情况差异均无统计学意义(均P0.05);但一期缝合术组术中出血量、术后禁食水时间、术后住院时间、住院费用均少于括约肌切开术组(均P0.05);并发症方面,一期缝合术组术后胆汁漏5例,括约肌切开术组术后急性胰腺炎6例,差异有统计学意义(均P0.05)。结论:不留置T管引流的腹腔镜胆总管探查胆道一期缝合术,可保留Oddi括约肌功能、避免长期留置T管,更显微创技术优势,是一种有效、可行的术式,值得临床应用。
[Abstract]:Objective: to investigate the clinical effect of no T tube drainage in the treatment of cholecystolithiasis complicated with choledocholithiasis. Methods: the clinical data of 100 patients with cholecystolithiasis complicated with choledocholithiasis from September 2013 to September 2014 were retrospectively analyzed. Among them 45 cases underwent laparoscopic cholecystectomy (LC) primary suture of common bile duct (primary suture group 55 cases LC endoscopic sphincterotomy of duodenal papilla (sphincterotomy group) all patients were followed up for 12 ~ 24 months. The clinical data of the two groups were compared and analyzed. Results: there was no significant difference in preoperative age, sex, bilirubin, transaminase and diameter of cholelithiasis between the two groups (all P 0.05), but the diameter of common bile duct dilation in the primary suture group was significantly larger than that in the sphincterotomy group. He was discharged from hospital after surgery. There was no significant difference between the two groups on the first day after operation, the time of operation, the time of total hospitalization, the residual condition of stone (all P 0.05), but the amount of blood lost during operation, the time of fasting water after operation, the time of hospitalization after operation in the primary suture group, and the duration of hospitalization after operation were not significantly different between the two groups (P < 0.05). The cost of hospitalization was less than that of sphincterotomy group (all P 0.05), and the complications were 5 cases in primary suture group and 6 cases in sphincterotomy group (all P 0.05). Conclusion: laparoscopic primary suture of common bile duct exploration without T-tube drainage can preserve the function of Oddi sphincter and avoid long-term indwelling of T-tube. It is an effective and feasible technique and is worthy of clinical application.
【作者单位】：郑州大学附属郑州中心医院肝胆胰外科;哈尔滨医科大学附属第二医院普通外科;
【基金】：河南省郑州市普通科技攻关资助项目(20150043)
【分类号】：R657.42

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