放置鼻胆管一期缝合胆总管与T管引流在腹腔镜及开腹胆囊切除、胆总管探查术中的对比研究  

A comparative study of intraoperative placement of nasobiliary duct,primary suture common bile duct and T tube drainage in laparoscopic and open cholecystectomy and common bile duct exploration

作　　者：刁红亮[1] 罗超英[1] 乌尔班提[1] 王金龙[1] 欧阳伟刚[1] 

机构地区：[1]克拉玛依市中心医院,新疆克拉玛依834000

出　　处：《腹腔镜外科杂志》2013年第9期691-694,共4页Journal of Laparoscopic Surgery

基　　金：克拉玛依市科研立项项目(编号:SK2012-41)

摘　　要：目的：探讨术中放置鼻胆管一期缝合胆总管与T管引流在腹腔镜与开腹胆囊切除、胆总管探查术中的应用方法及临床价值。方法：将52例胆总管结石并胆囊结石患者按住院时间分为开腹组（32例）及腹腔镜组（20例），根据胆总管直径选择普通胆道镜（6．0mm）行胆总管探查或超细胆道镜（2．7mm）行经胆囊管胆总管探查，术中采取顺逆结合法放置鼻胆管，一期缝合胆总管。观察经胆囊管胆总管探查成功率、胆漏及带管出院发生率、肠功能恢复时间、胆汁引流量、拔管时间、住院时间等指标。并与2010年1月至2010年12月46例开腹（开腹对照组）或腹腔镜（腹腔镜对照组）普通胆道镜胆总管探查＋T管引流患者的临床资料进行回顾性对比分析。结果：4组手术均获成功，腹腔镜组术后发生一过性胆漏2例，开腹组发生1例，均予以保守治疗痊愈。一期缝合的患者经胆囊管探查率、术后胆汁引流量、拔管时间、带管出院率明显优于T管引流的患者（P〈0．05）；腹腔镜组术后肠功能恢复时间、住院时间明显优于开腹组（P〈0．05）。4组患者胆漏发生率差异无统计学意义（P〉0．05）。均无胰腺炎、胆管炎等严重并发症发生。术后随访6—12个月，无胆总管狭窄及结石复发。结论：胆总管探查术中顺、逆法放置鼻胆管适合开腹及腹腔镜手术，一期缝合胆总管技术设备要求低，可显著提高经胆囊管入路胆总管探查一期缝合成功率，减少胆汁丢失，缩短带管时间与住院时间，尤其适于胆总管无明显扩张的胆总管结石患者，具有一定的临床应用价值，适合在基础医院开展。Objective：To discuss the methods and clinical value of intraoperative placement of nasobiliary duct, primary suture common bile duct and T tube drainage in laparoscopic or laparotomy cholecystectomy and common bile duct exploration. Methods：Fifty- two patients suffering from eholedocholithiasis combined with cholecystolithiasis were divided into laparoscopie group （20 cases） and Open surgery group （32 cases） according to the admission time. Cholecystectomy was performed. Accordance with the common bile duct diameter,the ordinary eholedoehoseope （6.0 ram） was chosen for common bile duct exploration,ultrafine choledoehoseope （2.7 ram） was used for trans-cystie duct common bile duct exploration. Antegrade and retrograde methods were used to place nasobiliary duct, then primary suture of the common bile duct was conducted. The success rate of trans-eystie duct common bile duct exploration, bile leakage and carrying tube discharge rate, bowel function recovery time, bile drainage volume, extubation and hospitalization time were observed, and 46 cases of open or laparoscopie common bile duct exploration with ordinary eholedochoscope （6.0 ram） ＋ T tube drainage from Jan. 2010 to Dee. 2010 were retrospectively and comparatively analyzed. Results：All operations were successfully completed, the prima- ry suture group was better than the T tube drainage group in the success rate of trans-cystic duet common bile duct exploration,postop- erative bile drainage volume, extubation time, carrying tube discharge rate （P 〈 0.05 ） ;Time of intestinal functional recovery and hospi- tal stay of laparoscopic group were less than those of laparotomy group （P 〈 0.05 ）. 2 cases of transient bile leakage was observed in laparoscopic group and 1 in open surgery group,which were self-healing after expectant treatment. No panereatitis, cholangitis or other severe complications occurred. Patients were followed up for 6 to 12 months and no common bile duct stricture or calculi recurrence were found. Concl

关 键 词：胆总管结石 鼻胆管 胆总管一期缝合 T管引流 腹腔镜检查 剖腹术 

分 类 号：R657.4[医药卫生—外科学]