腹腔镜经胆囊管胆总管探查术后一期缝合治疗肝外胆管结石的临床观察

摘要

Objective To investigate the clinical effects and feasibility of primary suture in patients with extrahepatic bile duct concretion after laparoscopic transcystic common bile duct exploration ( LTCBDE ). Methods The clinical data of 98 patients with extrahepatic bile duct concretion was retrospectively analyzed from October 2006 to December 2010, 56 cases were received primary suture treatment ( A group ) and 42 cases were received T duct drainage ( B group ). Clinical indicator between intraoperative and postoperative, and occurrence of perioperative complications were observed and compared. Results The anal ventilation time, postoperative fluid volume of the A group were significantly lower than those in the B group( P < 0.05, P <0. 01 ); Operation time and abdominal drainage duration of the two groups didn't have statistical significance (P > 0. 05 ). The postoperative hospital stay, hospital costs and time to resume normal life after surgery of group A were significantly lower than those in the group B( P < 0. 05, P <0.0l). There were no perioperative accident death in the two groups, the operations of the two groups were successful. Postoperative complication rate in A group was 10. 7% , while the B group was 28. 6% , the postoperative complication rate of two group was significantly differen( P <0. 05 ). Conclusion The primary suture after LTCBDE for treating the patients with extrahepatic bile duct concretion was better than conventional T-tube drainage, with the advantage of high operation successful rate, few postoperative complication rate, rapid postoperative recovery and short hospital stay. The surgery could be used as the primary method for treating the extrahepatic bile duct concretion.%目的 探讨腹腔镜经胆囊管胆总管探查术(LTCBDE)后一期缝合治疗肝外胆管结石的临床效果和可行性.方法 回顾性分析2006年10月-2010年12月行LTCBDE手术治疗的98例肝外胆管结石患者的临床资料,行LTCBDE手术治疗后56例行一期缝合(A组),42例行T管引流(B组).记录术中和术后的临床指标以及围手术期并发症发生情况.结果 A组肛门通气时间、术后输液量显著低于B组,差异有统计学意义(P<0.05,P<0.01);而2组手术时间、腹腔引流时间比较差异无统计学意义(P>0.05).A组术后住院时间、住院费用和术后恢复正常生活时间均显著低于B组,差异有统计学意义(P<0.05,P<0.01).2组围手术期均未出现意外事件致死病例,手术均获成功.A组术后并发症发生率(10.7%)低于B组(28.6%),差异有统计学意义(P<0.05).结论 LTCBDE术后胆管一期缝合治疗肝外胆管结石优于T管引流,具有手术成功率高、术后并发症少、术后恢复快和住院时间短的优点,可作为治疗肝外胆管结石优先考虑的手术方案.