摘要
目的探讨胆总管一期缝合术的相对优点、临床指征以及并发症预防措施。方法回顾性分析我院外科2003年11月至2007年3月间行胆总管一期缝合术的71例患者以及2006年10月至2007年3月间行T管引流术的128例患者的临床资料。结果胆总管一期缝合术组与T管引流术组的首次肛门排气时间、术后补液量、术后住院时间、住院费用分别为(2.16±0.56)d与(3.02±0.29)d,(10.05±2.73)L与(13.56±4.82)L,(9.73±2.76)d与(15.85±6.09)d,(8393±283)元与(9836±296)元,两组之间的差异有统计学意义(P<0.01)。胆总管一期缝合术组中31例患者依据胆道镜探查,40例依据术中取石与术前影像学检查相符合作为判断胆道不存在结石的依据;全组未见胆道结石残余,仅有7例患者并发一过性胆汁渗漏,均未经特殊处理而愈。结论①胆总管一期缝合术相对T管引流术有利于术后恢复。②术中确保胆道不存在残余结石和胆总管下端通畅是开展胆总管一期缝合术的前提条件。③严格掌握临床指征,注重处理要点是取得良好疗效的关键。
Objective To investigate the relative advantage, clinical indications and the preventive measures of primary closure of the common bileduct after choledochotomy. Methods Clinical data of 71 patients undergone primary closure of the common bile duct from November 2003 to March 2007 and 128 patients undergone T-tube drainage from October 2006 to March 2007 in our hospital were analyzed retrospectively, liesuits The time of the first postoperative aerofluxus, postoperative duration of hospitalization, the average volume of transfusion after surgery and the fee-for-service of the two groups were （2.16±0.56） vs （3.02±0.29）d, （9.73±2.76） vs （15.85±6.09）d, （10.05±2.73） vs （13.56±4.82）L and （8393±283.03） vs （9836±296.21）yuan. The differences between two groups were significant in statistics （P〈0.01）. To prove that there was no residual stone in the bile duct in the 71 patients with primary closure of the common bile duct, 31 patients underwent eholedoehoseope, the other 40 patients based on the identical outcomes of the preoperative inspections and the intra-operative situations. No residual stone was found in the 71 patients of primary duet closure group. Postoperative bile leakage was seen in 7 patients of primary duct closure group, and all of them recovered after conservative treatment. Conclusion ①Compared to T-tube drainage, the primary common bile duct closure is more helpful to postoperative recovery. ②The preconditions for the primary common bile duct closure are the guarantee of no residual stone and the guarantee of the unobstructed inferior extremity of common bile duct. ③To control strictly the clinical indications and the main points of treatment is the key of the primary common bile duet closure.
出处
《肝胆胰外科杂志》
CAS
2009年第1期31-33,共3页
Journal of Hepatopancreatobiliary Surgery
关键词
胆总管一期缝合术
胆道重建
临床指征
并发症
primary common bile duct closure
biliary reconstruction
clinical indications
complications
