胆道探查术后胆总管末端放置细支撑管联合胆总管一期缝合的临床价值

摘要

目的：探讨胆道探查术后胆总管末端放置细支撑管联合胆总管一期缝合的临床价值。方法回顾性分析460例胆总管结石患者的临床资料，根据治疗方法的不同分为A组224例及B组236例，两组患者均行胆道探查术治疗，术后A组行胆总管末端放置细支撑管联合胆总管一期缝合，B组行胆总管置T型管引流，比较两组手术时间、术中出血量、胃肠减压引流量、胃肠功能恢复时间、拔管时间、住院时间以及并发症发生情况。结果两组手术时间、拔管时间比较，差异无统计学意义（ P ＞0．05）；A 组术中出血量、术后胃肠减压引流量少于 B 组，胃肠功能恢复时间与住院时间短于 B 组（P＜0．05）。两组并发症发生率差异无统计学意义（P＞0．05），但A组胆漏发生率明显低于B组（P＜0．05）。结论胆道探查术后胆总管末端放置细支撑管联合胆总管一期缝合可降低胆漏的发生率，减少胃肠减压引流量，有助于患者胃肠功能的恢复，缩短住院时间，且安全性较高。%Objective To explore the clinical value of fine supporting tube embedding in terminal common bile duct combined with primary suture of common bile duct after bile duct exploration .Methods The clinical data of 460 patients with common bile duct stones were retrospectively analyzed .The patients were divided into Group A (n=224) and Group B(n=236) according to the therapies used .The bile duct exploration was performed in the patients of two groups .After surgery ,fine supporting tube embedding in terminal common bile duct combined with primary suture of common bile duct was conducted in Group A ,while type-T tube drainage embedding in common bile duct was conducted in Group B .The operative duration , intraoperative blood loss , drainage volume of postoperative gastrointestinal decompression,gastrointestinal function recovery time ,extubation time,hospital stay and incidence of complications were compared between two groups.Results There were no significant differences in the operative duration or extubation time between two groups (P>0.05).The intraoperative blood loss ,drainage volume of postoperative gastrointestinal decompression ,gastrointestinal function recovery time and hospital stays in Group A were less than those in Group B (P<0.05).There was no significant difference in the incidence of complications between two groups(P>0.05),But the incidence of bile leakage in Group A was significantly lower than that in Group B (P<0.05).Conclusion After bile duct exploration ,fine supporting tube embedding in terminal common bile duct combined with primary suture of common bile duct can reduce the incidence of bile leakage ,decrease the drainage volume of postoperative gastrointestinal decompression .It is helpful for the recovery of gastrointestinal function ,with less hospital stay and higher safety .