捆绑式鼻胆管支架在微创治疗肝外胆管结石中的应用探讨  

Application of endoscopic nasobiliary drainage tube bundled with stent in the minimally invasive treatment of extrahepatic bile duct calculi

作　　者：薛秀成[1] 李明娟[1] 王全[1] 黄伟强[1] 沈强[1] 张宁[1] XUE Xiu-cheng LI Ming-juan WANG Quan et al(Department of Surgery, the First People＇s Hospital of Jiashan, Jiaxing 314100, China)

机构地区：[1]嘉善县第一人民医院,浙江嘉兴314100

出　　处：《腹腔镜外科杂志》2017年第8期605-608,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)中置入捆绑式鼻胆管支架用于全保留Oddi括约肌功能微创治疗肝外胆管结石的可行性。方法:选择112例患者,随机分为3组,39例(LE组)行术前内镜逆行胰胆管造影/内镜十二指肠乳头括约肌切开术+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),36例(LT组)行LC+LCBDE+T管引流,37例(LES组)于LC+LCBDE术中置入捆绑式鼻胆管支架,比较各组手术时间、出血量、术后肛门恢复排气时间、拔管时间、住院时间、住院费用、患者满意度及术后并发症(胆漏、胆管残留结石)情况。结果:3组患者术中出血量、术后肛门排气时间、拔管时间及术后并发症差异无统计学意义(P>0.05)。LE组手术时间长于LES、LT两组(P<0.05),LE组与LES组住院时间短于LT组(P<0.05)。LE组、LT组日均补液量多于LES组(P<0.05)。LT组住院费用最低,LE组住院费用最高,LES组满意度最高,LT组最低,三组两两相比差异均有统计学意义(P<0.05)。结论:LCBDE术中置入捆绑式鼻胆管支架是安全、可行的。Objective： To investigate the feasibility of laparoscopic common bile duct exploration（ LCBDE） with insertion of endoscopic nasobiliary drainage tube bundled with stent in the minimally invasive treatment of extrahepatic bile duct calculi with preserving normal Oddi sphincter. Methods： One hundred and twelve patients of concomitant cholecystolithiasis and choledocholithiasis were randomly divided into 3 groups,39 patients（ Group LE） underwent endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy followed by laparoscopic cholecystectomy（ LC）,36 patients（ Group LT） underwent LC ＋ LCBDE with T-tube drainage,37 patients（ Group LES） underwent LC ＋ LCBDE with insertion of endoscopic nasobiliary drainage tube bundled with stent. Three groups were evaluated with regard to operating time,intraoperative bleeding,postoperative exhaust time,extubation time,hospital stay,hospitalization expenses,satisfaction of patients,complications（ bile leakage and bile duct residual calculi）. Results： There were no significant differences in intraoperative bleeding,postoperative exhaust time,extubation time,or complications among these groups（ P 0. 05）. The operating time in group LE was obviously longer than that in group LES and LT（ P 0. 05）. Postoperative hospital stay was significantly decreased in group LE and LES when compared to group LT（ P 0. 05）. The average amount of transfusion in group LE and LT was obviously more than that in group LES（ P 0. 05）. Group LT had the fewest hospitalization expenses and the highest hospitalization expenses was in group LE（ P 0. 05）. There were significant differences among the three groups in satisfaction（ P 0. 05）,satisfaction of group LES was the highest,while it was the lowest in group LT. Conclusions： The LCBDE with insertion of an endoscopic nasobiliary drainage tube bundled with stent is safe and feasible.

关 键 词：胆囊结石病 胆总管结石 腹腔镜检查 胆总管探查 鼻胆管支架 

分 类 号：R657.42[医药卫生—外科学]