【摘要】 目的探讨自行脱落胆道支架在腹腔镜胆总管探查一期缝合术中的应用。方法将80例胆囊结石合并胆总管结石患者按随机数字表法分为观察组和对照组,每组40例。2组均行腹腔镜下胆囊切除术及胆总管探查取石术,在术中观察组胆总管放置自行脱落胆道支架引流,对照组胆总管放置T管引流。观察2组术中出血量、手术时间、置管时间、肛门恢复排气时间、住院时间和结石残留率、胆漏发生率及术后1周肝功能(谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素)的变化。结果观察组手术时间、置管时间、肛门恢复排气时间、住院时间均较对照组短,术中出血量较对照组少(均P<0.05)。2组结石残留率、胆漏发生率和术后1周谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素值比较差异无统计学意义(P>0.05)。结论在腹腔镜下胆总管探查取石术中,胆总管内放置自行脱落胆道支架引流并行胆总管一期缝合,安全、有效,具有创伤小、康复快及住院时间短等优点,是治疗胆囊结石合并胆总管结石较理想的方法。更多还原

【Abstract】 Objective To explore the application of self-releasing biliary stent in primary closure following laparoscopic common bile duct exploration.Methods Eighty patients with gallstones and common bile duct stones were randomly divided into two groups,with 40 patients in each group.All patients underwent laparoscopic cholecystectomy and common bile duct exploration.Self-releasing biliary stent and conventional T tube were placed into common bile duct for drainage in observation group(n=40)and control group(n=40),respectively.Intraoperative blood loss,operation time,indwelling time,time to flatus,hospital stay,residual rate of calculus and incidence of bile leakage were observed in both groups.In addition,levels of alanine transaminase,aspartate transaminase,total bilirubin and direct bilirubin were determined 1week after operation.Results Compared with control group,self-releasing biliary stent drainage significantly shortened operation time,indwelling time,time to flatus and length of hospital stay and reduced intraoperative blood loss(P<0.05).There were no significant differences in residual rate of calculus,incidence of bile leakage,and levels of alanine transaminase,aspartate transaminase,total bilirubin and direct bilirubin between the two groups(P>0.05).Conclusion Self-releasing biliary stent drainage combined with primary closure is a safe,effective and ideal treatment for gallstones complicated by common bile duct stones,and results in less trauma,quicker recovery and shorter hospital stay in laparoscopic common bile duct exploration.更多还原