【摘要】 目的探讨胆总管侧壁T管引流术在腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)联合腹腔镜胆总管探查术(laparoscopic common bile duct exploration, LCBDE)应用的临床疗效。方法 2016年7月～2018年9月在我院行LC+LCBDE的175例胆囊合并胆总管结石患者,按随机数字表法分为两组,采用不同位置引出T管:胆总管前壁T管引流(前壁组)88例,胆总管侧壁T管引流(侧壁组)87例。比较两组术中出血量、T管放置时间、缝合胆总管时间、术后肛门排气时间、腹腔引流时间、胆汁引流量、术后至T管完全夹闭时间、住院时间、住院费用、患者耐受T管的主观感受及术后并发症等。结果两组患者术中出血量、术中安放T管时间、术后肛门排气时间、腹腔引流时间、日均胆汁引流量、术后至完全夹闭T管时间、术后住院时间、住院费用及患者耐受T管的VRS评分比较均无统计学差异(P>0.05),但侧壁组术中缝合胆总管时间较前壁组少,差异有统计学意义(P<0.05)。所有患者均获随访,时间2～36月。随访期内均未出现术后出血、腹腔感染、黄疸、急性胆管炎和急性胰腺炎等并发症,经T管胆道造影未见胆管狭窄,肝功能均恢复正常。术后前壁组发生胆漏7例,结石残留1例, T管拔除困难2例,侧壁组胆漏1例,结石残留1例;组间并发症率比较,差异有统计学意义(11.36%vs. 2.30%,P<0.05)。结论 LC+LCBDE胆总管侧壁T管引流较前壁T管引流更简单、易操作、更安全,值得推广。更多还原

【Abstract】 Objective To explore the clinical effect of T-tube drainage technique of common bile duct side wall during the surgery of laparoscopic cholecystectomy(LC) and laparoscopic common bile duct exploration(LCBDE). Methods A total of 175 cases with cholecystolithiasis combined choledocholithiasis performed LC and LCBDE admitted from July 2016 to September 2018 were divided randomly into two groups according to the random unmber table: 88 cases were carried out the anterior wall T-tube drainage as the anterior wall group; 87 cases were carried out the lateral wall T-tube drainage as the lateral wall group. The intra-operative blood loss, T tube placement time, common bile duct suturing time, anal exhaust time, abdominal drainage time, bile drainage volume, T-tube clamping time, hospital stay time, hospitalization cost, patient’s subjective feeling of tolerance of T tube and postoperative complications were compared between the two groups. ResultsThere was no statistical difference in intra-operative blood loss, T-tube placement time, post-operative anal exhaust time, abdominal drainage time, average daily bile drainage volume, T-tube clamping time, hospitalization time, hospitalization cost and VRS score between the two groups(P>0.05), but the suturing time of common bile duct was less in the lateral wall group than that in the anterior wall group( P< 0.05). All patients were followed up for 2 to 36 months without complications as postoperative hemorrhage,abdominal infection,jaundice,acute cholangitis and acute pancreatitis. No bile duct stenosis was found by T-tube cholangiography,and the liver function returned to normal in all cases. Bile leakage was found in 7 cases,residual calculi in 1 cases and difficulty of pulling out T-tube 2 in the anterior wall group,and bile leakage in 1 and residual calculi in 1 in the lateral wall group,and there was statistical difference in complication rate between the two groups( 11.36% vs. 2.30%,P< 0.05). Conclusion The T-tube drainage technique of common bile duct lateral wall is simpler,easier to operating and safer than the T-tube drainage of anterior wall,which is worth popularizing.更多还原