腹腔镜胆总管探查术联合经腹直肌引出T管与经右锁骨中线引出引流治疗胆总管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.02.034

摘要/Abstract

摘要： 目的比较研究在腹腔镜胆总管探查术(LCBDE)治疗胆总管结石(CBDS)患者时采取经腹直肌引出T管与经右锁骨中线引出T管引流疗效的差异。方法 2021年1月～2022年12月我院收治的CBDS患者198例, 其中A组125例接受LCBDE后T管经腹直肌引出引流, B组73例接受LCBDE后T管经右锁骨中线引出引流。记录两组围术期指标和并发症发生情况。使用全自动生化分析仪检测血生化指标。常规评估胃肠病生活质量指数(GIQLI)评分、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分。结果 A组手术时间、术中出血量、拔管时间和住院日分别为(52.9±3.1)min、(40.2±14.5)ml、(4.1±0.5)d和(7.2±1.1)d, 与B组【分别为(54.7±2.6)min、(39.8±15.9)ml、(5.0±0.7)d和(7.5±1.0)d, P>0.05】比, 无显著性差异;术后, A组血清TBIL、ALT、AST和ALB水平分别为(12.4±2.7)μmol/L、(51.8±4.2)U/L、(36.2±3.4)U/L和(37.9±1.5)g/L, 与B组【分别为(16.5±2.2)μmol/L、(54.7±5.0)U/L、(38.1±3.9)U/L和(37.4±2.0)g/L, P>0.05】比, 无显著性差异;A组GIQLI评分为(129.4±10.3)分, 显著高于B组(105.7±9.9)分, 而SDS评分和SAS评分分别为(30.2±1.7)分和(30.7±1.9)分, 显著低于B组【分别为(35.7±1.9)分和(37.4±2.2)分, P＜0.05】;术后, A组出血、感染、胆漏和胆管狭窄等并发症发生率为9.6%, 显著低于B组的20.5%(P＜0.05);术后随访1年, 超声检查显示, A组CBDS复发率为3.2%, 与B组的4.1%比, 无显著性差异(P＞0.05)。结论在采用LCBDE术治疗CBDS患者时, 采用经腹直肌引出引流管比经右锁骨中线引出引流管更能减轻患者心理压力, 有利于术后恢复。

关键词: 胆总管结石, 腹腔镜胆总管探查术, 经腹直肌引出引流管, 经右锁骨中线引出引流管, 治疗

Abstract: Objective The aim of this study was to compare the T-tube drainage through rectus abdominis and right midclavicular line after laparoscopic common bile duct exploration (LCBDE) in dealing with patients with common bile duct stones (CBDS). Methods A total of 198 patients with CBDS were admitted to our hospital between January 2021 and December 2022, all patients underwent LCBDE) operation, 125 cases in group A having T-tube drainage through rectus abdominis and 73 cases in group B having T-tube drainage through right midclavicular line. The perioperative indexes and complications in the two groups were recorded. The liver function tests were routinely detected. The gastrointestinal quality of life index (GIQLI) score, the self-rating depression scale (SDS) score and the self-rating anxiety scale (SAS) score were evaluated. Results The operation time, intra-operational blood loss, extubation time and hospital stay in group A were (52.9±3.1)min, (40.2±14.5)ml, (4.1±0.5)d and (7.2±1.1)d, all not significantly different compared to in group B; 5 days after operation, serum bilirubin, ALT, AST and albumin levels in group A were (12.4±2.7)μmol/L, (51.8±4.2)U/L, (36.2±3.4)U/L and (37.9±1.5)g/L, all not significantly different compared to in group B; the GIQLI score in group A was (129.4±10.3), much higher than (105.7±9.9), while the SDS score and the SAS score were (30.2±1.7) and (30.7±1.9), much lower than in group B; post-operationally, the incidence of complications, such as bleeding, infection, biliary leakage and cholangiostenosis in group A was 9.6%, much lower than 20.5%(P＜0.05) in group B; at the end of one-year follow-up, the recurrence of biliary stones revealed by ultrasonography in group A was 3.2%, not significantly different compared to 4.1% in group B (P＞0.05). Conclusion The T-tube drainage through rectus abdominis after LCBDE might ameliorate the mental strain in patients with CBDS, and reduce the incidence of postoperative complications.

Key words: Common bile duct stones, Laparoscopic common bile duct exploration, Drainage through rectus abdominis, Drainage through right midclavicular line, Therapy

唐昊, 杨天福. 腹腔镜胆总管探查术联合经腹直肌引出T管与经右锁骨中线引出引流治疗胆总管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 295-298.

Tang Hao, Yang Tianfu. Comparison of T-tube drainage through rectus abdominis and right midclavivular line after laparoscopic common bile duct exploration in dealing with patients with common bile duct stones[J]. Journal of Practical Hepatology, 2024, 27(2): 295-298.

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腹腔镜胆总管探查术联合经腹直肌引出T管与经右锁骨中线引出引流治疗胆总管结石患者疗效研究^*

Comparison of T-tube drainage through rectus abdominis and right midclavivular line after laparoscopic common bile duct exploration in dealing with patients with common bile duct stones

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