陈华强 余德刚 陈波 江东桥 朱大学 杨小松 陈淑

[摘要] 目的 探讨LCBDE术后行一期缝合与T管引流治疗肝外胆管结石临床疗效及安全性差异。方法 随机选取2012年4月—2014年4月该院与遵义医学附院收治的肝外胆管结石患者160例，采用随机抽样方法分为A组和B组，每组80例，分别行LCBDE术后行一期缝合与T管引流治疗；比较两组患者围手术期临床指标、手术费用、结石残余率及术后并发症发生率等。 结果 A组患者术后输液量、排气时间及住院时间均显著优于B组，差异有统计学意义（P<0.05）；A组患者手术费用显著多于B 组，差异有统计学意义（P<0.05）；两组患者结石残余率比较差异无统计学意义（P>0.05）；A组患者术后并发症发生率显著低于A组，差异有统计学意义（P>0.05）。结论 相较于T管引流，LTCBDE术后行一期缝合治疗肝外胆管结石可加快术后康复进程，降低术后并发症发生风险。

[关键词] LCBDE；一期缝合；T管引流；肝外胆管结石

[中图分类号] R65 [文献标识码] A [文章编号] 1674-0742（2015）08（c）-0054-03

Clinical Comparative Study of Primary Suture and T Tube Drainage in Treatment of Extrahepatic Bile Duct Stones After LCBDE

CHEN Hua-qiang1， YU De-gang2， CHEN Bo1， JIANG Dong-qiao1， ZHU Da-xue1， YANG Xiao-song1， CHEN Shu1

1. Department of General Surgery， Xishui Lvzhou Hospital， Zunyi， Guizhou Province， 564600 China；2. Department of Hepatobiliary Surgery， Affiliatde Hospital of Zunyi Medical Colloge， Zuiyi， Guizhou Province， 563000 China

[Abstract] Objective To compare the clinical effects and safety between primary suture and T tube drainage in the treatment of extrahepatic bile duct stones after LCBDE. Methods 160 patients with extrahepatic bile duct stones enrolled between April 2012 and April 2014 in our hospital were randomly divided group A with 80 patients undergoing primary suture after LCBDE， and group B with 80 patients receiving T tube drainage after LCBDE； and the perioperative clinical indexes， operation cost， residual stones rate and postoperative complication rate were compared between the two groups. Results Postoperative infusion volume， exhaust time and hospitalization time were all less in the group A than in the group B with statistically significant differences（P<0.05）； the operation cost was more in the group A than in the group B with statistically significant difference（P<0.05）； no statistically significant difference was observed in residual stone rate between the two groups（P﹥0.05）， postoperative complication rate was lower in the group A than group B（P<0.05）. Conclusion Compared with T tube drainage， primary suture in the treatment of extrahepatic bile duct stones after LCBDE can efficiently speed up recovery process and reduce the risk of postoperative complications.

[Key words] LCBDE； Primary suture； T tube drainage； Extrahepatic bile duct stones

作为普外科常见疾病类型之一，肝外胆管结石治疗以外科手术治疗为主[1]；传统剖腹胆道探查取石术疗效令人满意，但术中创伤较大，严重影响术后康复进程[2]。目前随着腹腔镜技术发展成熟，腹腔镜胆总管探查术（LCBDE）开始广泛应用于临床治疗，但有关术后T管引流摆放与否问题仍然存在较大争议。该次研究随机选取2012年4月—2014年4月该院普外科和遵义医学院肝胆外科近期收治肝外胆管结石患者160例，分别行LCBDE术后行一期缝合与T管引流治疗；比较两组患者围手术期临床指标、手术费用，结石残余率及术后并发症发生率等，探讨LCBDE术后行一期缝合与T管引流治疗肝外胆管结石临床疗效及安全性差异，现报道如下。