腹腔镜胆总管切开术:T管引流还是一期缝合

目的探讨腹腔镜胆总管切开术T管引流与一期缝合的适应证、手术特点及胆道并发症的防治。方法回顾性对比分析1997年11月～2005年11月该院116例腹腔镜胆总管切开术：T管引流组（54例）与一期缝合组（62例）的临床资料。结果对比两组胆总管内径、手术时间、术后胆漏及胆管狭窄，差异均无统计学意义（P〉0.05），一期缝合组术后胃肠功能恢复时间、补液时间及住院时间显著缩短（P〈0.01）。无手术死亡病例。结论腹腔镜胆总管切开术选择T管引流还是一期缝合，取决于其适应证。一期缝合的适应证较为严格，主要为术中取石干净及胆总管通畅，其手术效果明显优于T管引流；T管引流为术后胆道造影及胆道镜处理残留结石提供了有效途径。只有严格按照手术适应证并熟练掌握手术要点，才能有效防止胆道并发症的发生。

Laparoscopic choledochotomy: T-tube drainage or primary closure

[Objective] To explore indications,surgical characteristics,prevention and management of biliary complications of T-tube drainage(TD)and primary closure(PC)during laparoscopic choledochotomy(LCD).[Methods] 116 cases underwent LCD in our hospital from Nov.1997 to Nov.2005.Clinical data of group TD(54 cases)and group PC(62 cases)were studied comparatively and retrospectively.[Results] There were no significance in diameter of common bile duct,operative time,postoperative bile leakage and bile duct stricture between two groups(P >0.05).Postoperative period of gastrointestinal function recovery,fluid infusion and hospital stay had been shortened significantly in group PC(P <0.01).There was no operative death.[Conclusions] Choice of TD or PC during LCD depends on their indications.Indications for PC including mainly clearance and no stricture of common bile duct are more strict than that for TD.Postoperative effects of PC are better than that of TD significantly.But T-tube provides an effective access for choangiography and retained stones management by choledochoscopy.Indications must be chosen precisely and laparoscopic techniques should be improved in order to prevent biliary complications effectively.