腹腔镜胆总管探查术后一期缝合与T管引流的临床研究_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 徐红星 , 徐海宾 , 顾玉青 , 顾强 , 汪意青

江苏省太仓市第一人民医院肝胆外科（江苏太仓 215400）;

Corresponding author：

徐红星, Email: xuhongxing61@163.com

Keywords：

胆总管探查术; 腹腔镜; 一期缝合; T管引流

DOI：

10.7507/1007-9424.20150325

Video：

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目的探讨腹腔镜胆总管探查术后一期缝合与T管引流的手术疗效。方法回顾性分析2012年1月至2013年12月期间太仓市第一人民医院肝胆外科行腹腔镜胆总管探查术50例患者的临床资料，其中18例行胆总管一期缝合，32例行胆总管T管引流，分析2组患者的临床疗效。结果 50例患者无中转开腹，均治愈出院。缝合组及引流组平均胆总管直径分别为（10.6±1.5）mm及（11.3±1.5）mm，胆总管结石数分别为（3.0±2.0）枚及（3.2±2.2）枚，平均结石直径分别为（5.5±1.6）mm及（5.8±2.1）mm，其差异均无统计学意义（P＞0.05）。缝合组和引流组手术时间分别为（107.9±20.3）min和（101.6±36.4）min，分别于手术后（3.8±1.0）d和（3.3±1.0）d拔除腹腔引流管，总住院时间分别为（11.6±3.1）d和（12.0±2.2）d，术后恢复时间分别为（8.9±0.9）d和（7.4±1.1）d，其差异也无统计学意义（P＞0.05）。缝合组和引流组患者住院总费用分别为（14 525.1±2 274.6）元和（16 568.3±2 701.5）元，缝合组住院总费用低于引流组（P＜0.05）。引流组术后有结石残留1例，发生胆汁漏1例；缝合组无并发症发生。结论与T管引流相比，腹腔镜胆管探查术后一期缝合不增加手术时间、总住院时间、术后恢复时间及术后引流时间，而能减少住院总费用，在合适的病例中，腹腔镜下胆总管探查术后一期缝合安全有效。

Citation： 徐红星, 徐海宾, 顾玉青, 顾强, 汪意青. 腹腔镜胆总管探查术后一期缝合与T管引流的临床研究. 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.	陈超波, 仇毓东, 顾盐炎, 等.胆囊结石合并胆总管结石两种微创术式比较的Meta分析.中华肝胆外科杂志, 2013, 19(10):752-757.
5.	陈盛, 郑江华, 区应亮, 等.两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较.中国普外基础与临床杂志, 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.	王帅, 黄汉飞, 段键, 等.胆总管一期缝合术与T型管引流术治疗胆总管结石的对比研究.中华普通外科杂志, 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.	赵国刚, 李德新, 李强, 等.胆道镜联合钬激光经T管窦道治疗肝内外胆管残余结石.中国普通外科杂志, 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.	张宝华, 张永杰, 张柏和, 等.术后胆漏的综合处理.中国实用外科杂志, 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. 陈超波, 仇毓东, 顾盐炎, 等.胆囊结石合并胆总管结石两种微创术式比较的Meta分析.中华肝胆外科杂志, 2013, 19(10):752-757.
5. 陈盛, 郑江华, 区应亮, 等.两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较.中国普外基础与临床杂志, 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. 王帅, 黄汉飞, 段键, 等.胆总管一期缝合术与T型管引流术治疗胆总管结石的对比研究.中华普通外科杂志, 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. 赵国刚, 李德新, 李强, 等.胆道镜联合钬激光经T管窦道治疗肝内外胆管残余结石.中国普通外科杂志, 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. 张宝华, 张永杰, 张柏和, 等.术后胆漏的综合处理.中国实用外科杂志, 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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