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目的比较腹腔镜胆总管切开探查术(LCBDE)胆总管一期缝合和T管引流治疗老年胆总管结石合并2型糖尿病(T2DM)患者的疗效。方法腹腔镜下胆总管切开探查+纤维胆道镜取石治疗老年胆总管结石合并T2DM患者65例,其中术后采用胆总管一期缝合33例为A组,采用T管引流术32例为B组。比较两组手术时间、术中出血量、术后住院时间、补液量、住院费用及并发症发生率。结果与B组比较,A组手术时间短、术后住院时间短、补液量少、住院费用少、发热时间短,两组比较差异均有统计学意义(t分别=2.13、2.61、3.78、3.29、3.02,P均<0.05);A组并发胆漏、胆管狭窄、腹腔感染、结石残余和胆管炎的发生率与B组比较,差异均无统计学意义(χ2分别=3.58、2.61、4.27、3.88、3.51,P均>0.05)。结论与术后采用T管引流术比较,胆总管探查术后一期缝合对于老年胆总管结石合并T2DM患者是安全可靠的。
Objective To compare the efficacy of primary LCBDE and T-tube drainage in the treatment of senile choledocholithiasis with type 2 diabetes mellitus (T2DM) by laparoscopic common bile duct exploration (LCBDE). Methods 65 cases of senile choledocholithiasis combined with T2DM were treated by laparoscopic choledochotomy and choledochofiberscopy. Among them, 33 cases of primary choledocholithotomy were group A, 32 cases of group B were treated by T tube drainage, . The operation time, intraoperative blood loss, postoperative hospital stay, fluid replacement, hospitalization costs and complication rates were compared between the two groups. Results Compared with group B, group A had shorter operation time, shorter postoperative hospitalization time, less fluid replacement, less hospitalization expense and shorter fever duration. The differences between the two groups were statistically significant (t = 2.13, 2.61, 3.78, 3.29 , 3.02, P <0.05). There was no significant difference in the incidence of gallbladder leakage, bile duct stricture, abdominal infection, residual stones and cholangitis between group A and group B (χ2 = 3.58,2.61,4.27, 3.88,3.51, P> 0.05). Conclusions Compared with postoperative T-tube drainage, primary suture of common bile duct exploration is safe and reliable for elderly patients with common bile duct stones and T2DM.