腹腔镜胆总管切开取石术后MRCP与T管造影的对照研究

摘要 目的：评估磁共振胰胆管造影（Magnetic Resonance Cholangiopancreatography, MRCP）是否可以成为腹腔镜胆总管切开取石术后T管造影的替代方法。方法：回顾性分析我院普外科自2017年1月至2020年12月收治的胆总管结石患者的临床资料，共收集接受腹腔镜胆总管切开取石术+T管引流术患者263例，将其中拔除T管前行MRCP者54例定为MRCP组，连续选取拔除T管前行T管造影者54例为T管造影组。对两组患者的检查结果、不良反应发生率、住院治疗比例、检查至拔T管时间、抗生素使用率、相关医疗费用等指标进行记录并分析。结果：T管造影组与MRCP组诊断胆总管残余结石的阳性率、假阳性率和准确率无统计学差异（P＞0.05）。T管造影组不良反应发生率、住院治疗比例、检查至拔T管时间、抗生素使用率和相关医疗费用均显著高于MRCP组，两组差异有统计学意义（P＜0.05）。结论：MRCP可替代T管造影作为腹腔镜胆总管切开取石术后拔除T管前的诊断方法。

A Comparative Study of MRCP and T-tube Cholangiography after Laparoscopic Choledocholithotomy

ABSTRACT Objective: To evaluate whether MRCP can be used as an alternative to T-tube cholangiography after laparoscopic choledocholithotomy. Methods: The clinical data of 263 patients with choledocholithiasis who underwent laparoscopic choledocholithotomy combined with choledochoscopy and T-tube drainage from January 2017 to December 2020 were retrospectively analyzed. 54 cases who MRCP was performed before T-tube removed were defined as MRCP group. 54 continuous selected cases who T-tube cholangiography was performed before T-tube removed were defined as T-tube cholangiography group. The data of the incidence of complications, the proportion of hospitalization, the time of extubation, the proportion of antibiotic usage and the related medical costs were recorded and analyzed. Results: There was no statistical difference in the positive rate, false positive rate and imaging accuracy between T-tube group and MRCP group in diagnosis of residual common bile duct stones(P>0.05). The incidence of adverse reactions, the proportion of hospitalization, the time from imaging examination to extubation, the rate of antibiotic usage and the related medical costs in T-tube group were significantly higher than those in MRCP group, and the differences between the two groups were statistically significant(P<0.05). Conclusion: MRCP can replace T-tube cholangiography as a diagnostic method before removal of T-tube post Laparoscopic Choledocholithotomy.