老年患者腹腔镜胆总管一期缝合与留置T管治疗胆囊结石合并胆总管结石的临床疗效分析*

Clinical efficacy analysis of laparoscopic primary suture of common bile duct and retention of T-tube in treatment of choledocholithiasis in elderly patients*

摘要:

摘要：目的??探讨腹腔镜胆总管一期缝合与留置T管治疗老年胆囊结石合并胆总管结石患者的临床效果。方法 回顾性分析2013年1月－2018年1月该科收治并行腹腔镜胆总管探查术的老年患者临床资料106例，根据手术方法分成一期缝合组与T管引流组，比较两组胆总管缝合时间、术中出血量、术后肛门排气时间、术后疼痛评分、术后C反应蛋白（CRP）水平、术后并发症发生情况、引流管拔除时间、住院时间、住院费用和结石残留复发等指标。结果 106例患者均在腹腔镜下完成手术，其中一期缝合组在胆管缝合时间、肛门排气时间、术后疼痛评分、住院时间和住院费用[（13.6±3.6）和（21.5±11.8）min、（1.6±0.6）和（2.1±0.7）d、（1.4±0.2）和（3.2±0.8）分、（7.3±2.1）和（9.6±3.5）d、（21?564.7±4?962.5）和（25?376.6±6?537.1）元]均优于留置T管组（P??0.05）。结论 老年胆囊结石合并胆总管结石患者行腹腔镜胆总管一期缝合相比留置T管有一定优势，值得在基层医院适当推广。

Abstract:

Abstract: Objective?To investigate the clinical effect of laparoscopic primary suture of common bile duct and retention of T-tube in treatment of aged patients with choledocholithiasis.?Methods?Clinical data of 106 elderly patients with laparoscopic common bile duct exploration from January 2013 to January 2018 were analyzed retrospectively. According to the operation mode, they were divided into two groups: primary suture group and T-tube drainage group. The suture time of common bile duct, intraoperative bleeding volume, postoperative anal exhaust time, postoperative pain score, postoperative CRP level, postoperative complications and drainage tube removal time, length of hospital-stay, cost of hospitalization, residual recurrence of stone and so on were compared between the two groups.?Results?All the operations were performed under laparoscope. In the primary suture group, the suture time of bile duct, anal exhaust time, postoperative pain score, hospitalization time, hospitalization cost [(13.6?±?3.6) vs (21.5?±?11.8) min, (1.6?±?0.6) vs (2.1?±?0.7) d, (1.4?±?0.2) vs (3.2?±?0.8), (7.3?±?2.1) vs (9.6?±?3.5)?d, (21?564.7?±?4?962.5) vs (25?376.6?±?6?537.1) yuan] were better than those in the T tube group (P??0.05).?Conclusion?Laparoscopic primary suture of choledocholithiasis in elderly patients with choledocholithiasis has some advantages over T-tube indwelling. It is worth popularizing in basic hospitals.