Sheen-Chen S M, Chou F F
Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, R.O.C.
Acta Chir Scand. 1990 May;156(5):387-90.
Thirty patients with stones in the common bile duct were allocated alternately to have choledocholithotomy carried out with either T-tube drainage or with primary closure. Choledochoscopy was done during every operation, and the patency of the common bile duct tested by perfusion. There were no operative deaths. The length of operation was shorter with primary closure (p less than 0.01) but there were no differences between the groups in operative blood loss, days in hospital after operation, postoperative morbidity and mortality, and final outcome at follow up. There was no change in the incidence of postoperative bacteraemia, the number of adverse reactions, and the incidence of bile peritonitis after removal of the T-tube. Patients who had T-tubes reported greater discomfort and inconvenience than those without, and their treatment cost more. We conclude that primary closure of the common bile duct is a reasonable alternative to T-tube drainage in selected cases.
30例胆总管结石患者被交替分配接受胆总管切开取石术，分别采用T管引流或一期缝合。每次手术均进行胆管镜检查，并通过灌注检测胆总管的通畅情况。无手术死亡病例。一期缝合组手术时间较短（p<0.01），但两组在术中失血量、术后住院天数、术后发病率和死亡率以及随访最终结果方面无差异。拔除T管后，术后菌血症发生率、不良反应数量和胆汁性腹膜炎发生率均无变化。留置T管的患者比未留置T管的患者报告有更大的不适和不便，且治疗费用更高。我们得出结论，在某些特定病例中，胆总管一期缝合是T管引流的合理替代方法。
