CAJ | 학술논문

目的探讨腹腔镜胆总管探查取石术后一期缝合而不放置引流管的安全性.方法前瞻性研究2011年1月至2013年6月中山大学孙逸仙纪念医院收治的40例行腹腔镜胆总管探查取石术患者的临床资料.采用随机数字表法将患者分成2组,其中研究组(20例)术后不放置引流管,对照组(20例)于肝下放置引流管.比较两组患者的手术时间、住院时间及术后并发症情况.患者术后1个月及3个月复查CT及B超,之后每6个月复查1次,直至术后3年.随访时间截至2013年7月31日.计量资料比较采用独立样本t检验,计数资料比较采用Fisher确切概率法.结果两组患者术后均康复出院.研究组患者手术时间为(117±11)min,住院时间为(5.6±0.6)d;对照组手术时间为(108±12) min,住院时间为(7.9±0.7)d,两组比较,差异有统计学意义(t=2.453,-11.388,P＜0.05).两组患者术后均无胆汁漏、结石残留、梗阻性黄疸、腹腔出血及膈下感染等并发症发生.31例患者获得随访,随访时间1个月至2年.随访期内未发现胆管结石复发或胆管狭窄.结论腹腔镜下胆总管切开探查取石后一期缝合胆总管而不放置任何引流管安全可行.
목적 탐토복강경담총관탐사취석술후일기봉합이불방치인류관적안전성.방법 전첨성연구2011년1월지2013년6월중산대학손일선기념의원수치적40례행복강경담총관탐사취석술환자적림상자료.채용수궤수자표법장환자분성2조,기중연구조(20례)술후불방치인류관,대조조(20례)우간하방치인류관.비교량조환자적수술시간、주원시간급술후병발증정황.환자술후1개월급3개월복사CT급B초,지후매6개월복사1차,직지술후3년.수방시간절지2013년7월31일.계량자료비교채용독립양본t검험,계수자료비교채용Fisher학절개솔법.결과 량조환자술후균강복출원.연구조환자수술시간위(117±11)min,주원시간위(5.6±0.6)d;대조조수술시간위(108±12) min,주원시간위(7.9±0.7)d,량조비교,차이유통계학의의(t=2.453,-11.388,P＜0.05).량조환자술후균무담즙루、결석잔류、경조성황달、복강출혈급격하감염등병발증발생.31례환자획득수방,수방시간1개월지2년.수방기내미발현담관결석복발혹담관협착.결론 복강경하담총관절개탐사취석후일기봉합담총관이불방치임하인류관안전가행.
Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.