目的 比较腹腔镜胆总管切开取石一期缝合术(LBEPS)与腹腔镜胆总管切开取石、T管引流术(LCTD)治疗胆总管结石的临床效果.方法 选择高州市人民医院2009年9月～2012年2月收治的胆总管结石患者64例,根据手术方法不同分为治疗组(腹腔镜胆总管切开取石一期缝合术)与对照组(腹腔镜胆总管切开取石、T管引流术),各32例.观察并比较两组的平均手术时间、引流时间、术后患者下床活动时间、术后住院时间、并发症等情况.结果 与对照组比较,治疗组患者手术时间短[(98.95±11.52)min]、术后下床活动时间早[(1.92±0.12)d],引流时间短[(2.43±0.19)d]、术后住院时间短[(7.8±1.7)d],差异有统计学意义(P＜0.05)；治疗组并发症的发生率(9.4％)明显低于对照组(28.1％)(P＜0.05).治疗组胆管压力术后第1天较术中升高[(14.89±2.57)mm Hg比(12.15±3.68)mm Hg](P＜0.05),而术后第3、5天胆管压力逐渐降低,术后第5天胆管压力降低至最低[(11.73±1.95)mm Hg]；对照组术后第1天胆管压力与术中比较差异无统计学意义(P＞0.05),但随着治疗时间的延长其胆管压力呈逐渐降低趋势,且与术后第1天比较,对照组的胆管压力术后第5天下降最明显,差异有统计学意义[(9.45±1.03)mm Hg比(11.07±2.69)mm Hg](P＜0.05).结论 腹腔镜胆总管切开取石一期缝合术治疗胆总管结石具有创伤小、痛苦少、患者术后恢复快的优点,是治疗胆总管结石的理想手术方式之一,值得推广和应用.%Objective To compare the clinical effects of laparoscopic common bile duct exploration and primary suture and laparoscopic choledocholithotomy and T-tube drainage in the treatment of choledocholithiasis.Methods In Gaozhou People's Hospital from September 2009 to February 2012,64 patients with choledocholithiasis were selected and divided into two groups,according to the different surgery methods,each group had 32 cases.The treatment group was given laparoscopic common bile duct exploration and primary suture treatment,and the control group was given laparoscopic choledocholithotomy and T-tube drainage treatment.The average operation time,drainage time,postoperative ambulation,postoperative hospital stay,and complications were compared between the two groups.Results Compared with the control group,the patients in the treatment group had shorter operation time [(98.95±11.52)min],earlier postoperative bed activity time [(1.92±0.12)d],shorter drainage time [(2.43±0.19)d],shorter postoperative hospital stay [(7.8±1.7)d],the differences were statistically significant(P＜0.05); the incidence of complications in the treatment group(9.4％)was significantly lower than the control group(28.1％)(P＜0.05).Compared with the intraoperative,in the treatment group the bile duct pressure significant increased [(14.89±2.57)mm Hg vs(12.15±3.68)mm Hg](P＜0.05)in the first day after surgery; 3,5 days after surgery,the bile duct pressure gradually decreased,in fifth days after surgery,the bile duct pressure reduced to the lowest [(11.73±1.95)mm Hg].Compared with the intraoperative,bile duct pressure of the control group in the first day after surgery had no significant difference(P＞0.05),its bile pressure gradually decreased with the time of treatment,and compared with the first day after surgery,bile duct pressure of the control group decreased to the lowest in the fifth day after surgery [(9.45±1.03)mm Hg vs(11.07±2.69)wn Hg],the difference was statistically significant(P＜0.05).Conclusion The laparoscopic common bile duct exploration and primary suture for choledocholithiasis has advantages of less invasive,less painful,quick recovery.It is one of the ideal surgical approach for the treatment of common bile duct stones,and it is worthy of promotion and application.
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