腹腔镜胆总管一期缝合联合经腹置入鼻胆管在术后胆漏预防中的作用  

Prevention of bile leakage after laparoscopic primary suturing of common bile duct by transabdominal placement of nasal bile duct

作　　者：张胜龙[1] 陈安平[1] 索运生[1] 刘进衡 Zhang Shenglong;Chen Anping;Suo Yunsheng;Liu Jinheng(Department of Hepatobiliary Surgery,Second People's Hospital of Chengdu,Chengdu 610017,China)

机构地区：[1]成都市第二人民医院肝胆外科,61OO17

出　　处：《中华肝胆外科杂志》2020年第2期100-102,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨腹腔镜胆总管一期缝合联合经腹置入鼻胆管引流在预防术后胆漏中的作用。方法 回顾性分析成都市第二人民医院腹腔镜胆总管一期缝合置入(引流组)和未置入鼻胆管引流(未引流组)患者的临床资料。结果 未引流组286例患者术后发生胆漏32例(11.2%);引流组350例患者术后发生胆漏11例(3.1%),两组胆漏发生率差异有统计学意义(P<0.05)。当胆总管直径≤11.0 mm时,未引流组与引流组的胆漏发生率分别为18.5%(20/108)和2.1%(3/143),引流组发生率明显低于未引流组,差异具有统计学意义(P<0.05);胆总管直径大于11.0 mm时,未引流组与引流组胆漏发生率差异无统计学意义(P>0.05)。结论 腹腔镜胆总管一期缝合可以根据胆总管的直径选择是否需要置入鼻胆管引流。当患者胆总管直径≤11.0 mm时,建议置入鼻胆管引流,以减少胆漏的发生。Objective To study the advantages of laparoscopic primary suturing of common bile duct plus transabdominal nasobiliary drainage in reducing the rate of bile leakage.Methods The clinical data of laparoscopic primary suturing of common bile duct with or without nasal bile duct drainage in Second Peoples Hospital of Chengdu were analyzed retrospectively.Results During laparoscopic common bile duct exploration,286 patients were treated by primary suturing without nasobiliary drainage(group without d rainage),including 32(11.2%)patients with bile leakage;350 patients were treated by primary suturing with transabdominal nasobiliary drainage(group with drainage),including 11(3.1%)patients with bile leakage.The incidences of bile leakage of the two groups were significantly different(P<0.05).When the diameter of the common bile duct was less than 11.0 mm,the incidence of bile leakage in the non-drainage group and the drainage group were 18.5%(20/108)and 2.1%(3/143),respectively.The incidence in the drainage group was significantly lower than that in the non-drainage group,and the difference was statistically significant(P<0.05).When the diameter of common bile duct was larger than 11.0 mm,there was no significant difference in the incidences of bile leakage between the two groups(P>0.05).Conclusions The choice after laparoscopic primary suturing of common bile duct between with or without nasobiliary drainage should be determined according to the diameter of common bile duct.When a common bile duct diameter of less than 11.0 mm,nasobiliary drainage is recommended to reduce the rate of bile leakage.

关 键 词：胆总管结石 腹腔镜 胆道镜 鼻胆管 

分 类 号：R657[医药卫生—外科学]