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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 646 -648. doi: 10.3877/cma.j.issn.1674-3946.2019.06.032.

所属专题： 文献；

论著

腹腔镜胆总管探查免T管引流治疗胆总管结石的临床分析
祁亚斌1,†(), 金雷1, 雷凯1, 郝君锋1, 赵伟2, 高校奇1   
  1. 1. 710054　陕西省西安市第九医院普外二科
    2. 710061　西安交通大学第一附属医院普通外科
  • 收稿日期:2019-04-20 出版日期:2019-12-26
  • 通信作者: 祁亚斌

Clinical analysis of laparoscopic common bile duct exploration with free T-tube in the treatment of common bile duct stones

Yabin Qi1,†(), Lei Jin1, Kai Lei1, Junfeng Hao1, Wei Zhao2, Xiaoqi Gao1   

  1. 1. Second Department of General Surgery, Xi’an Ninth Hospital 710054
    2. Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University 710061, China
  • Received:2019-04-20 Published:2019-12-26
  • Corresponding author: Yabin Qi
  • About author:
    Corresponding author: Qi Yabin, Email:
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祁亚斌, 金雷, 雷凯, 郝君锋, 赵伟, 高校奇. 腹腔镜胆总管探查免T管引流治疗胆总管结石的临床分析[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 646-648.

Yabin Qi, Lei Jin, Kai Lei, Junfeng Hao, Wei Zhao, Xiaoqi Gao. Clinical analysis of laparoscopic common bile duct exploration with free T-tube in the treatment of common bile duct stones[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 646-648.

目的

探讨腹腔镜胆总管探查免T管引流手术治疗胆总管结石的临床疗效。

方法

回顾性分析2012年3月至2018年12月住院手术的胆总管结石患者122例的临床资料，其中行腹腔镜胆总管探查免T管手术62例(免T管组)，腹腔镜胆总管探查＋T管引流术60例(T管组)。应用SPSS 17.0软件进行统计学分析，手术指标、生活质量评分(GIQLI)以(±s)表示，采用独立t检验；术后并发症发生率比较采用χ2检验，P<0.05为差异具有统计学意义。

结果

免T管组行经胆囊管途径取石10例，行胆总管切开取石一期缝合胆总管52例。两组术中出血量、住院费用、并发症发生率差异无统计学意义(P>0.05)，而手术时间、首次肛门排气时间、术后住院时间免T管组优于T管组(P<0.05)。术后2周及4周GIQLI评分免T管组优于T管引流组(P<0.05)，术后8周两组差异无统计学意义(P>0.05)。

结论

胆总管结石病人行胆总管探查取石免T管手术安全可行，可以缩短住院时间，利于胃肠道功能恢复，避免T管相关并发症，并能提高病人生活质量。

关键词: 胆总管结石, 腹腔镜, 免置T管
Objective

To explore the clinical effect of laparoscopic common bile duct exploration without T-tube in the treatment on common bile duct stones.

Methods

122 cases of patients with common bile duct stones treated from March 2012 to December 2018 were selected and analyzed retrospectively. All the patients were divided into free T-tube group and T-tube drainage group according to the therapeutic procedure. 62 patients were received laparoscopic common bile duct exploration without T-tube, while 60 patients were treated with laparoscopic common bile duct exploration with T-tube drainage. The SPSS 17.0 was used for statistical analysis, the operative parameters and GIQLI score were presented as (±s) and compared by t test, and postoperative complications were compared by chi square test. A P<0.05 was considered as significant difference.

Results

In the free T-tube group, 10 cases received laparoscopictranscystic common bile duct explaration and 52 cases had laparoscopic choledocholithotomy plus primary biliary suture. The operative time, the primary exhaust time, postoperative hospital stay were lower in the free T-tube group than those in the T-tube drainage group. There was no significant difference between the two groups in the intraoperative blood, postoperative complications. The GIQLI scores in the free T-tube group were significantly higher than those in the T-tube drainage group at 2 and 4 weeks postoperatively, and there was no statistical difference at 8 weeks after operation.

Conclusion

Laparoscopic common bile duct exploration with free T tube is safe and feasible in the treatment of common bile duct stone. It can shorten the operative time and postoperative hospital stay, promote patients gastrointestinal function recovery, and improve patient quality of life after surgery.

Key words: Choledocholithiasis, Laparoscopes, Free t-tube
表1 122例胆总管结石患者术后不同引流方式两组患者基本资料比较[(±s)，例]
组别 例数 年龄(岁) 性别 BMI(kg/m2)
男/女
免T管组 62 55.4±12.2 27/35 25.6±2.7
T管组 60 54.3±10.8 28/32 25.2±2.8
t/χ2值 ? 0.53 0.12 0.80
P值 ? 0.60 0.73 0.42
组别 例数 胆总管直径(cm) 胆总管结石数量(个) 胆总管结石直径(cm)
免T管组 62 1.5±0.4 2.4±0.9 1.1±0.5
T管组 60 1.6±0.5 2.3±1.0 1.2±0.6
t/χ2值 ? 1.22 0.58 1.00
P值 ? 0.22 0.56 0.32
表2 122例胆总管结石患者术后不同引流方式两组患者手术相关指标对比(±s)
组别 出血量(ml) 手术时间(min) 首次排气时间(h) 术后住院时间(d) 住院费用(万元)
免T管组 28.4±6.5 114.6±30.2 27.6±7.3 6.1±1.8 1.6±0.3
T管组 30.7±7.6 128.5±27.4 38.4±7.6 7.9±1.7 1.7±0.3
t值 1.80 2.66 8.01 5.67 1.12
P值 0.07 0.009 0.00 0.00 0.26
表3 122例胆总管结石患者术后不同引流方式两组患者手术前后生活质量GIQLI评分[(±s)，分]
组别 术前 术后2周 术后4周 术后8周
免T管组 102.4±10.8 115.5±12.7 122.6±10.5 124.1±9.3
T管组 104.3±11.2 106.8±14.3 112.4±12.6 121.8±11.5
t值 0.95 3.56 4.86 1.22
P值 0.34 0.00 0.00 0.23
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