术中置自制新型鼻胆管、胆总管一期缝合在胆总管探查术中的应用  

Intraoperative installation of neotype nasobiliary duct in primary suture after choledochotomy

作　　者：郭子健[1] 李莉华[1] 过建工[1] 周鹏[1] 戴赛民[1] 张勇[1] 

机构地区：[1]苏州大学附属第四医院肝胆外科,无锡市214062

出　　处：《中华肝胆外科杂志》2006年第8期527-529,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：无锡市科技局课题(HS20030011)

摘　　要：目的探讨术中置自制新型鼻胆管、胆总管一期缝合替代 T 管引流术的临床价值。方法 2002年10月至2004年10月,共施行术中置自制新型鼻胆管、胆总管一期缝合术34例,并与同期32例传统 T 管引流术、6例直接胆总管一期缝合术相比较。手术方法为切开胆总管取净结石,鼻胆管引导器插入胆总管通过十二指肠乳头进入十二指肠,引导器开口指向幽门。内镜活检钳在鼻胆管引导器的导引下进入十二指肠并向上通过幽门到达胃腔,活检钳在胃腔内夹住术前置入的鼻胃管前端的尾状乳胶条,将鼻胃管导入十二指肠、十二指肠乳头进入胆总管,再由鼻胃管引导新型鼻胆管进入十二指肠,最后出外鼻孔。新型鼻胆管头端的环型乳胶弹力圈支撑于肝总管内,一期缝合胆总管。术后5～7 d 拔除鼻胆管。结果 34例术中置新型鼻胆管成功率100%,无一例发生胆漏,拔管时间(5.0±1.5)d、术后住院时间(9.2±1.3)d 较 T 管引流组(分别为15.2±3.6 d、17.1±5.6 d)短,差异有显著性(P<0.01)。结论术中置新型鼻胆管、胆总管一期缝合术适应证广、操作简单、安全可靠,彻底消除了 T 型管引流所致胆漏等并发症,缩短了住院天数,值得进一步推广。Objective To evaluate the safety and feasibility of the intraoperative installation of neotype nasobiliary duct （NNBD）, a new operative procedure, in primary suture after common bile duct （CAD） incision and exploration instead of T-tube drainage. Methods From October 2002 to October 2004, 34 patients underwent NNaD placement during the operation in our hospital. Their data were compared with those of the 32 patients receiving T-tube drainage and 6 without biliary drainage in the same period of time. NNaD conductor was inserted into the duodenal lumen through CBD and duodenal papilla after CBD exploration and stone removal. The endoscopic forceps was inserted into gastric cavity through the NNaD conductor to clamp the tail of nasogastric tube and pull it into CBD. With the guidance of nasogastric tube, the NNaD was successfully placed in the CBD. Then latex loop of the distal end of NNBD was supported at the common hepatic duct.CBD was interruptedly sutured after confirmation of no residual stones. Choledochoscopy and water injection test showed that there were no constriction and bile leakage. NNBD was withdrawn 5-7 d after the operation. Results No bile leakage was fund in the 34 patients receiving the NNBD. The successful rate of the procedure was 100%. The removal time and duration of postoperative hospitalization in the patients receiving NNBD were significantly different from those in the patients receiving Ttube drainage （P〈0. 01 ）. Conclusions This method is simple, safe and can prevent occurrence of bile leakage and reduce complications.

关 键 词：胆道外科手术 鼻胆管 胆总管切开术 胆漏 一期缝合 

分 类 号：R657.4[医药卫生—外科学]