CAJ | 학술논문

目的总结胆总管探查术后一期缝合术与T管引流术治疗胆总管结石的经验,探讨其各自适应证以及评价其临床疗效.方法将2008年6月至2012年1月入住昆明医学院第一附属医院器官移植中心253例肝外胆管结石患者随机分为一期缝合组和T管引流组,通过独立样本的t检验比较患者手术并发症及术后恢复情况.结果所有患者手术均成功,一期缝合组2例出现手术并发症,术后有少量胆漏,经腹腔引流管充分引流后治愈.T管引流组5例出现手术并发症,其中4例术后少量胆漏,经充分引流后自愈,1例出现逆行胆道感染,给予胆道冲洗、抗感染治疗后痊愈.两组的胆漏引流液均为胆汁样,每天约5～10 ml,经充分引流后于3～4d自行消失,均未出现发热、黄疸等症状,也未出现胰腺炎等严重并发症.两组患者术后胆道并发症发生率(P=0.802)、手术时间(P =0.137)、术中出血量(P=0.069)差异均无统计学意义；一期缝合组术后排气时间(P =0.037)、术后补液量(P=0.008)、术后住院时间(P=0.015)均低于T管引流组,两组差异有统计学意义.结论胆总管探查术后一期缝合是安全有效可行的手术方式,一期缝合减黄效果与放置T管引流效果相同或相近.
목적 총결담총관탐사술후일기봉합술여T관인류술치료담총관결석적경험,탐토기각자괄응증이급평개기림상료효.방법 장2008년6월지2012년1월입주곤명의학원제일부속의원기관이식중심253례간외담관결석환자수궤분위일기봉합조화T관인류조,통과독립양본적t검험비교환자수술병발증급술후회복정황.결과 소유환자수술균성공,일기봉합조2례출현수술병발증,술후유소량담루,경복강인류관충분인류후치유.T관인류조5례출현수술병발증,기중4례술후소량담루,경충분인류후자유,1례출현역행담도감염,급여담도충세、항감염치료후전유.량조적담루인류액균위담즙양,매천약5～10 ml,경충분인류후우3～4d자행소실,균미출현발열、황달등증상,야미출현이선염등엄중병발증.량조환자술후담도병발증발생솔(P=0.802)、수술시간(P =0.137)、술중출혈량(P=0.069)차이균무통계학의의；일기봉합조술후배기시간(P =0.037)、술후보액량(P=0.008)、술후주원시간(P=0.015)균저우T관인류조,량조차이유통계학의의.결론 담총관탐사술후일기봉합시안전유효가행적수술방식,일기봉합감황효과여방치T관인류효과상동혹상근.
Objective To evaluate upfront common bile duct suturing against T-tube drainage after exploration in the treatment of common bile duct stone.Methods 253 cases of extrahepatic bile duct stones treated at our department from 2008 June to 2012 January were randomly divided into primary suture group and T tube drainage group,by t test or analysis of variance independent sample comparison.Results All operations were successful.Postoperative bile leakage was observed in 2 patients in group A and 4 in group B respectively(P ＞ 0.05),there was no reoperations in the two groups.In group B retrograde biliary tract infection developed in one and was cured by biliary tract flush combined with antibiotics administration.The abdominal drainage was bile tainted fluid about 5-10 ml a day in bile leakage cases in both groups and healed itself in 3-4 days without fever,jaundice symptoms.There was no other severe complications such as pancreatitis.The postoperative biliary complication rate (P =0.802),operative time (P =0.137),intraoperative blood loss (P =0.069) and liver function recovery(ALT P =0.087,AST P =0.752,TBIL P =0.459,DBIL P =0.217,ALP P =0.576,GGT P =0.362) was not significantly different between the two groups.In group A postoperative flatus passing (P =0.037),postoperative fluid volume (P =0.008),postoperative hospital stay(P =0.015) were better than that in T-tube drainage group.At 3 to 12 months follow-up,no patients were found to have residual stones and biliary stricture in group A and group B.Conclusions With the definite indication and proficient surgical technology,primary suture of common bile duct after exploration is a safe and effective way after treatment of choledocholithiasis.