腹腔镜胆总管探查术后一期缝合与T 管留置的疗效比较

目的：比较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2011年1月—2012年8月施行的71例腹腔镜下胆总管探查取石术患者的临床资料，其中一期缝合39例（缝合组），T管引流32例（引流组），比较两组术中、术后情况。结果：两组手术时间、术后住院时间、开始流质时间差异均无统计学意义（均P>0.05），但缝合组腹腔引流时间及总住院费用明显少于引流组（均P<0.05）。两组术后胆瘘、胆管炎、残余结石等并发症发生率差异均无统计学意义（均P>0.05）。两组均无术后胆管狭窄和死亡病例。结论：腹腔镜胆管探查术后一期缝合在术后引流时间和治疗费用方面比与T管引流更具优势，在合适的适应证下应作为治疗的首选。

Primary closure versus T-tube drainage after laparoscopic common bile duct exploration

Objective: To compare the effects of primary closure and T-tube drainage following laparoscopic common bile duct exploration (LCBDE). Methods: The clinical data of 71 patients who underwent LCBDE for stone extraction from January 2011 to August 2012 were retrospectively analyzed. Of the 71 patients, 39 cases underwent primary closure (suture group) and 32 cases received T-tube drainage (drainage group) after LCBDE. The intra- and postoperative conditions between the two groups were compared. Results: There were no significant differences between the two groups in the operative time, length of postoperative hospital stay and time to liquid intake (all P>0.05), but abdominal drainage time and hospital costs in suture group were significantly lower than those of drainage group (both P<0.05). The incidences of postoperative complications such as bile leakage, cholangitis and retained stones between the two groups showed no statistical difference (P>0.05). No bile duct stricture or death occurred in either group. Conclusion: Primary closure has reduced duration of postoperative drainage and hospital cost compared with T-tube drainage following LCBDE, and thus, it could be proposed as the method of first choice under appropriate indications.