本文關(guān)鍵詞： 腹腔鏡 一期縫合 T管引流 膽總管結(jié)石 膽囊結(jié)石　出處：《延安大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較分析腹腔鏡膽總管探查一期縫合膽總管與腹腔鏡膽總管探查T管引流的臨床療效,探討腹腔鏡膽囊切除并膽總管探查后一期縫合膽總管治療膽囊結(jié)石合并膽總管結(jié)石的可行性、安全性及應(yīng)用價(jià)值。方法:依據(jù)入選標(biāo)準(zhǔn)對(duì)我院(延安大學(xué)附屬醫(yī)院)自2014年10月至2016年12月診斷為膽囊結(jié)石合并膽總管結(jié)石行腹腔鏡下膽囊切除并膽總管探查術(shù)的58例患者臨床資料進(jìn)行回顧性分析。根據(jù)腹腔鏡膽總管探查術(shù)后膽總管一期縫合還是T管引流分為兩組:一期縫合組(PS組)25例、T管引流組(TD組)33例,分別比較兩組之間的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后腹腔引流量、術(shù)后輸液量、術(shù)后首次肛門排氣時(shí)間、術(shù)后住院天數(shù)、住院費(fèi)用及術(shù)后并發(fā)癥發(fā)生情況。結(jié)果:兩組患者術(shù)后均未出現(xiàn)死亡病例。PS組vs TD組:在術(shù)中出血量(ml)(41.00±17.80 vs 39.00±14.06 P=0.634)、術(shù)后腹腔引流量(ml)[34.00(14.00~41.50)vs 20.00(17.00~32.00)P=0.352]等方面,兩組之間差異無(wú)統(tǒng)計(jì)學(xué)意義;然而在手術(shù)時(shí)間(min)(130.44±12.07 vs 165.00±22.81 P=0.000)、術(shù)后輸液量(ml)(10771.60±1666.84 vs 12462.06±877.35 P=0.000]、肛門首次排氣時(shí)間(h)[42.00(38.00~45.50)vs 44.00(43.50~46.00)P=0.001]、術(shù)后住院時(shí)間(d)[7.00(6.00~8.00)vs 8.00(7.00~8.50)P=0.010]、住院費(fèi)用(元)(21374.12±1003.08 vs 22756.18±1327.83 P=0.000)等方面,PS組均明顯優(yōu)于TD組,兩組之間差異有統(tǒng)計(jì)學(xué)意義;在術(shù)后并發(fā)癥方面:PS組術(shù)后出現(xiàn)1例輕微膽漏;TD組出現(xiàn)1例輕微膽漏,1例膽總管結(jié)石殘留,1例T管拔除后膽汁性腹膜炎,1例低鉀血癥,1例代謝性酸中毒綜合征,PS組術(shù)后并發(fā)癥發(fā)生率與TD組之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者術(shù)后平均隨訪13個(gè)月(3~24個(gè)月),均未見(jiàn)明顯的膽道狹窄。結(jié)論:腹腔鏡膽總管探查一期縫合膽總管較T管引流具有手術(shù)時(shí)間短、術(shù)后輸液量少、消化道功能恢復(fù)快、術(shù)后住院時(shí)間短、住院費(fèi)用低等明顯優(yōu)勢(shì),腹腔鏡膽總管探查一期縫合膽總管并不增加術(shù)后并發(fā)癥發(fā)生率,且獲得良好的臨床療效。因此做到術(shù)前評(píng)估選擇合適的病例,術(shù)中熟練掌握腹腔鏡及膽道鏡相關(guān)操作技術(shù)結(jié)合良好的腔鏡下縫合打結(jié)技術(shù),并掌握腹腔鏡膽總管探查一期縫合膽總管的適應(yīng)癥,腹腔鏡膽囊切除并膽總管探查后一期縫合膽總管治療膽囊結(jié)石合并膽總管結(jié)石的臨床療效是安全、有效、可行的,值得臨床開展應(yīng)用。
[Abstract]:Objective: To compare the clinical efficacy of laparoscopic choledochotomy with primary suture of common bile duct and T tube drainage of laparoscopic common bile duct exploration, to explore the feasibility of laparoscopic cholecystectomy and common bile duct after primary suture of common bile duct in treatment of cholecystolithiasis complicated with choledocholithiasis, safety and clinical value. Methods: according to the inclusion criteria in our hospital (Affiliated Hospital of Yan'an University from October 2014 to December 2016) for the diagnosis of the clinical data of 58 cases of resection of gallbladder and common bile duct stones underwent laparoscopic cholecystectomy and choledochotomy were retrospectively analyzed. According to the laparoscopic common bile duct after common bile duct suture or T tube drainage were divided into two groups: a suture group (PS group) in 25 cases, T tube drainage group (TD group) 33 cases, were compared between the two groups of operation time, bleeding volume, postoperative drainage volume, postoperative infusion volume, postoperative anal exhaust Time, postoperative hospital stay, hospitalization expenses and postoperative complications. Results: two groups of patients were no deaths in the.PS group vs TD group: intraoperative blood loss (ML) (41 + 17.80 vs 39 + 14.06 P=0.634), postoperative abdominal drainage (ML [34.00 (14) ~41.50) vs 20 (17.00~32.00) P=0.352], there was no significant difference between the two groups; however, at the time of surgery (min) (130.44 + 12.07 vs 165 + 22.81 P=0.000), postoperative infusion volume (ML) (10771.60 + 1666.84 vs 12462.06 + 877.35 P=0.000], first anal exhaust time (H ([42.00) 38.00~45.50) vs 44 (43.50~46.00) P=0.001], postoperative hospitalization time (d) [7.00 (6.00~8.00) vs 8 (7.00~8.50) P=0.010], the hospitalization expenses (yuan) (21374.12 + 1003.08 vs 22756.18 + 1327.83 P=0.000) and PS group were significantly better than TD group, there were statistically significant differences between the two groups in complications; after the party Surface: PS group postoperative bile leakage occurred in 1 cases of mild TD group; 1 cases of mild bile leakage, 1 cases of residual common bile duct stones, 1 cases of bile peritonitis after removal of T tube, 1 cases of hypokalemia, 1 cases of metabolic acidosis syndrome PS, postoperative complication rate and the difference between TD group had no statistical significance (P0.05); the average follow-up of the two groups of patients after 13 months (3~24 months), there were no obvious bile duct stenosis. Conclusion: laparoscopic choledochotomy with primary suture of common bile duct with T tube drainage with shorter operation time, less postoperative infusion volume, gastrointestinal function recovery after surgery, shorter hospital stay, hospitalization cost advantages, laparoscopic choledochotomy with primary suture of common bile duct does not increase the incidence of postoperative complications, and obtain good clinical curative effect. So evaluation of selected cases of preoperative, intraoperative skilled laparoscopic and choledochoscopic technique combined with good correlation operation Endoscopic suturing and knotting technique, and master the laparoscopic choledochotomy with primary suture of common bile duct indications, clinical curative effect of laparoscopic cholecystectomy and common bile duct after primary suture of common bile duct in treatment of cholecystolithiasis and choledocholithiasis is safe, effective, feasible, worthy of clinical application.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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