腹腔鏡膽總管探查術后一期縫合與T管引流的臨床研究_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 徐紅星 , 徐海賓 , 顧玉青 , 顧強 , 汪意青

江蘇省太倉市第一人民醫院肝膽外科（江蘇太倉 215400）;

Corresponding?author：

徐紅星, Email: xuhongxing61@163.com

Keywords：

膽總管探查術; 腹腔鏡; 一期縫合; T管引流

DOI：

10.7507/1007-9424.20150325

Video：

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目的探討腹腔鏡膽總管探查術后一期縫合與T管引流的手術療效。方法回顧性分析2012年1月至2013年12月期間太倉市第一人民醫院肝膽外科行腹腔鏡膽總管探查術50例患者的臨床資料，其中18例行膽總管一期縫合，32例行膽總管T管引流，分析2組患者的臨床療效。結果 50例患者無中轉開腹，均治愈出院。縫合組及引流組平均膽總管直徑分別為（10.6±1.5）mm及（11.3±1.5）mm，膽總管結石數分別為（3.0±2.0）枚及（3.2±2.2）枚，平均結石直徑分別為（5.5±1.6）mm及（5.8±2.1）mm，其差異均無統計學意義（P＞0.05）。縫合組和引流組手術時間分別為（107.9±20.3）min和（101.6±36.4）min，分別于手術后（3.8±1.0）d和（3.3±1.0）d拔除腹腔引流管，總住院時間分別為（11.6±3.1）d和（12.0±2.2）d，術后恢復時間分別為（8.9±0.9）d和（7.4±1.1）d，其差異也無統計學意義（P＞0.05）。縫合組和引流組患者住院總費用分別為（14 525.1±2 274.6）元和（16 568.3±2 701.5）元，縫合組住院總費用低于引流組（P＜0.05）。引流組術后有結石殘留1例，發生膽汁漏1例；縫合組無并發癥發生。結論與T管引流相比，腹腔鏡膽管探查術后一期縫合不增加手術時間、總住院時間、術后恢復時間及術后引流時間，而能減少住院總費用，在合適的病例中，腹腔鏡下膽總管探查術后一期縫合安全有效。

Citation： 徐紅星, 徐海賓, 顧玉青, 顧強, 汪意青. 腹腔鏡膽總管探查術后一期縫合與T管引流的臨床研究. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(10): 1254-1256. doi: 10.7507/1007-9424.20150325 Copy

1.	Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7):1004-1021.
2.	Chan DS, Jain PA, Khalifa A, et al. Laparoscopic common bile duct exploration. Br J Surg, 2014, 101(11):1448-1452.
3.	Dong ZT, Wu GZ, Luo KL, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res, 2014, 189(2):249-254.
4.	陳超波, 仇毓東, 顧鹽炎, 等.膽囊結石合并膽總管結石兩種微創術式比較的Meta分析.中華肝膽外科雜志, 2013, 19(10):752-757.
5.	陳盛, 鄭江華, 區應亮, 等.兩種微創方式治療膽囊結石合并膽總管結石的臨床療效比較.中國普外基礎與臨床雜志, 2012, 19(11):1213-1217.
6.	Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1):28-33.
7.	El-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy. J Gastrointest Surg, 2010, 14(5):844-848.
8.	王帥, 黃漢飛, 段鍵, 等.膽總管一期縫合術與T型管引流術治療膽總管結石的對比研究.中華普通外科雜志, 2013, 28(5):351-353.
9.	Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
10.	JCh B, Dron B, Charbonneau P, et al. Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients:indications and results. Surg Endosc, 2007, 21(11):1970-1974.
11.	趙國剛, 李德新, 李強, 等.膽道鏡聯合鈥激光經T管竇道治療肝內外膽管殘余結石.中國普通外科雜志, 2012, 21(8):922-925.
12.	Anwar S, Rahim R, Agwunobi A, et al. The role of ERCP in management of retained bile duct stones after laparoscopic cholecystectomy. N Z Med J, 2004, 117(1203):U1102.
13.	Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database Syst Rev, 2013, 6:CD005640.
14.	張寶華, 張永杰, 張柏和, 等.術后膽漏的綜合處理.中國實用外科雜志, 2002, 22(2):106-107.
15.	Agarwal N, Sharma BC, Garg S, et al. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int, 2006, 5(2):273-277.

1. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7):1004-1021.
2. Chan DS, Jain PA, Khalifa A, et al. Laparoscopic common bile duct exploration. Br J Surg, 2014, 101(11):1448-1452.
3. Dong ZT, Wu GZ, Luo KL, et al. Primary closure after laparoscopic common bile duct exploration versus T-tube. J Surg Res, 2014, 189(2):249-254.
4. 陳超波, 仇毓東, 顧鹽炎, 等.膽囊結石合并膽總管結石兩種微創術式比較的Meta分析.中華肝膽外科雜志, 2013, 19(10):752-757.
5. 陳盛, 鄭江華, 區應亮, 等.兩種微創方式治療膽囊結石合并膽總管結石的臨床療效比較.中國普外基礎與臨床雜志, 2012, 19(11):1213-1217.
6. Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg, 2010, 145(1):28-33.
7. El-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy. J Gastrointest Surg, 2010, 14(5):844-848.
8. 王帥, 黃漢飛, 段鍵, 等.膽總管一期縫合術與T型管引流術治療膽總管結石的對比研究.中華普通外科雜志, 2013, 28(5):351-353.
9. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage:a randomized clinical trial. J Surg Res, 2009, 157(1):e1-e5.
10. JCh B, Dron B, Charbonneau P, et al. Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients:indications and results. Surg Endosc, 2007, 21(11):1970-1974.
11. 趙國剛, 李德新, 李強, 等.膽道鏡聯合鈥激光經T管竇道治療肝內外膽管殘余結石.中國普通外科雜志, 2012, 21(8):922-925.
12. Anwar S, Rahim R, Agwunobi A, et al. The role of ERCP in management of retained bile duct stones after laparoscopic cholecystectomy. N Z Med J, 2004, 117(1203):U1102.
13. Gurusamy KS, Koti R, Davidson BR. T-tube drainage versus primary closure after open common bile duct exploration. Cochrane Database Syst Rev, 2013, 6:CD005640.
14. 張寶華, 張永杰, 張柏和, 等.術后膽漏的綜合處理.中國實用外科雜志, 2002, 22(2):106-107.
15. Agarwal N, Sharma BC, Garg S, et al. Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int, 2006, 5(2):273-277.

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腹腔鏡膽總管探查術后一期縫合與T管引流的臨床研究

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