腹腔镜胆总管探查术置管一期缝合与T管引流的对照研究

摘要

Objective:To compare the clinical results of endobiliary stent drainage with primary closure versus T-tube drainage after laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. Methods:Between Jun. 2010 and Oct. 2011 48 patients diagnosed as choledocholithiasis were treated by LCBDE. Their clinical data were retrospectively analyzed. After extraction of the calculi,T-tubes were placed in 36 patients (T-tube group) and endobiliary stenta were placed in 12 patients (stent group).The common bile ducts were primarily closed in stent group. The clinical data such as age,sex,operative time,intraoperative blood loss,postoperative hospital stay and complications were comparatively analyzed between 2 groups. Results: The differences of age, sex, operative time and intraoperative blood loss between two groups were not statistically significant (P > 0.05 ). The postoperative hospital stay in stent group was (6.0±1.7) d while (11.1 ±7.2) d in T-tube group ( P < 0.05). Postoperative complications were observed in 4 patients (33.3% ) of stent group and in 9 patients (25% ) of T-tube group (P =0. 710). Bile leakage occurred in one patient with T-tube,who was treated with aspiration of bile under ultrasonic guidance. Culture of bile was positive in 1 case;The difference of complication rate between two groups was not statistically significant (P > 0.05). The endobiliary stent and T-tube were removed 2 weeks and 6-8 weeks after surgery, respectively. Conclusions: The drainage with endobiliary stent is safe and can be used as replacement of T-tube after LCBDE. Placement of a endobiliary stent and primary closure of the common bile duct can reduce the postoperative hospital stay and improve the life quality of patients.%目的:对比腹腔镜胆总管探查术中植入“胆道支撑内引流管”一期缝合与留置T管引流治疗胆总管结石的临床疗效.方法:回顾分析2010年6月至2011年10月48例腹腔镜胆总管切开探查术的临床资料.其中36例留置T管(T管组),12例留置胆道支撑内引流管一期缝合(缝合组).对比分析两组患者年龄、性别、手术时间、术中出血量、术后住院时间及并发症等指标.结果:两组患者年龄、性别、手术时间及术中出血量差异均无统计学意义(P＞0.05).缝合组术后住院时间短于T管组.缝合组术后4例(33％)发生并发症；T管组9例(25％)发生并发症,其中1例术后胆漏,在超声引导下穿刺抽液治疗,1例胆汁培养阳性；两组并发症总体发生率差异无统计学意义(P＞0.05).缝合组于术后2周拔除胆道支撑内引流管,T管组于术后6～8周拔除T管.结论:胆道支撑内引流管在腹腔镜胆总管探查术中可代替T管起到安全减压及支撑作用,术中植入胆道支撑内引流管并一期缝合胆总管可缩短术后住院时间,提高患者生活质量.