【摘要】 目的 比较腹腔镜胆总管探查后免T管法(胆总管一期缝合及经胆囊管取石)与T管引流法治疗胆总管结石的临床疗效及安全性。方法 回顾性分析芜湖市第二人民医院2018年3月至2021年8月期间收治的28例行免T管腹腔镜胆总管探查的胆总管结石患者的临床资料,随机选取同期行T管引流法腹腔镜胆总管探查术的胆总管结石的患者28例作为对照组,比较两组术中一般情况如手术成功率(有无中转开腹及术后结石残余),手术时间,术中出血量;以及两组患者术后相关指标如术后首次肛门排气时间,术后住院时间,术后各时间节点疼痛视觉模拟法评分(VAS)及术后并发症等指标的差异。结果免T管组与T管引流组相比,在平均手术时间、术后首次肛门排气时间、术后住院时间以及术后各时间点VAS评分均有明显优势,P <0.05;而在术后总体并发症发生率方面,两组相比较无明显差异。结论 腹腔镜胆总管探查后免T管法与T管引流法均是安全、可靠的术式,免T管法可以加快患者术后康复,在熟练掌握腹腔镜技术及严格把握手术适应证的前提下值得临床推广。更多还原

【Abstract】 Objective To compare the clinical efficacy and safety of T-tube free method(Laparoscopic common bile duct exploration with primary suture,LBEPS and Laparoscopic transcystic common bile duct exploration,LTCBDE) and T-tube drainage method in the treatment of common bile duct stones after laparoscopic common bile duct exploration.Methods The clinical data of 28patients with common bile duct stones who underwent t-tube-free laparoscopic common bile duct exploration in the Second People’s Hospital of Wuhu from March 2018 to August 2021 were retrospectively analyzed.28 patients with common bile duct stones who underwent T-tube drainage laparoscopic common bile duct exploration in the same period were randomly selected as the control group.The general conditions of the two groups were compared,such as operation success rate(whether there was conversion to laparotomy and postoperative stone residue),operation time and blood loss;And the differences of postoperative related indexes between the two groups,such as the first postoperative anal exhaust time,postoperative complications,postoperative hospital stay and visual analogue scale(VAS) of pain in each time period.Results There was no significant difference in gender,age,diameter of common bile duct and other related indicators between the two groups(P>0.05).All 56 patients in both groups underwent surgery successfully;Among them,2 patients in the T-tube drainage group were converted to laparotomy due to difficulties in suturing and fixing the T-tube and dissecting the gallbladder triangle.All patients in the T-tube free group underwent laparoscopic surgery successfully.Compared with T-tube drainage group,T-tube free group had significant advantages in average operation time,first postoperative anal exhaust time and postoperative hospital stay,the difference was statistically significant(P <0.05),while there was no significant difference in the overall incidence of postoperative complications between the two groups(P> 0.05).Meanwhile,there was no significant difference in preoperative Pain Visual Analogue Score between the two groups(P> 0.05);Pain Visual Analogue Score at 6 hours,12 hours and 24 hours after operation in T-tube free group were significantly lower than those in T-tube drainage group(P <0.05).Conclusion For patients with common bile duct stones,under the condition of strictly mastering the surgical indications,the T-tube free method and T-tube drainage method after laparoscopic common bile duct exploration are safe and reliable.T-tube free method can accelerate the postoperative rehabilitation of patients,the specific operation method should also be reasonably selected according to the general situation of patients before operation and the exploration during operation.更多还原