摘要
目的比较腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)后一期缝合与T管引流治疗老年胆总管结石患者的临床疗效.方法回顾分析2011-2016年67例接受腹腔镜下胆总管探查术的老年胆总管结石患者的临床资料,其中34例行一期缝合,33例放置T管引流,分析比较两种手术方式的安全性及术后并发症情况.结果两组手术时间、术中出血量及腹腔引流管拔除时间均无统计学差异(P>0.05),而一期缝合组肛门排气时间(2.0 d±0.6 d)、术后住院时间(9.6 d±2.2 d)明显短于T管引流组(P<0.05).两组术后并发症发生率无统计学差异(P>0.05),其中一期缝合组患者术后出现胆漏1例、结石复发1例,T管引流组术后出现水电解质紊乱2例、残余结石1例.结论对于老年胆总管结石患者,在LCBDE后,如严格掌握适应证、操作技术熟练,一期缝合是安全、有效的,且相对T管引流,患者的生活质量较高.
AIM To compare the clinical efficacy of primary suture and T tube drainage following laparoscopic common bile duct exploration（LCBDE） in elderly patients with choledocholithiasis.METHODS The clinical data for 67 elderly patients with choledocholithiasis undergoing LCBDE from January 2011 to December 2016 were analyzed retrospectively.Of the 67 patients,34 underwent primary duct closure and 33 underwent T-tube drainage after choledochotomy.Security and postoperative complications between the two groups were compared.RESULTS There were no significant differences in operative time,intraoperative blood loss,or time of removal of abdominal drainage tube between the two groups（P〉0.05）.Primary duct closure was significantly superior to T-tube drainage with regard to time to first exhaust（2.0 d±0.6 d） and postoperative hospital stay（9.6 d±2.2 d）.In the primary duct closure group,postoperative bile leakage and recrudescent calculus occurred in one case each.In the T-tube drainage group,two cases suffered from electrolyte disturbance and one case from retained calculus.There was no significant difference in postoperative complications between the two groups（P 0.05）.CONCLUSION Primary duct closure following LCBDE is safe and effective under the premise of following strict surgical indication and grasping skillful technology.Patients receiving primary duct closure can achieve better quality of life compared with those undergoing T-tube drainage.
出处
《世界华人消化杂志》
CAS
2017年第1期91-95,共5页
World Chinese Journal of Digestology
关键词
老年胆总管结石
腹腔镜检查
一期缝合
T管引流
Elderly patients
Choledocholithiasis
Laparoscopy
Primary suture
T-tube drainage
作者简介
郑伟，主治医师，主要从事肝胆胰腹腔镜外科及术后快速康复方面的研究
通讯作者：张云，主任医师，214200，江苏省宜兴市通真观路75号，江苏大学附属宜兴医院肝胆外科staff784@yxph.com电话：051O-87921241
