胆总管探查一期缝合鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石的临床研究  

Clinical research of nasobiliary drainage and T tube drainage after common bile duct exploration in the treatment of cholecystolithiasis combined with choledocholithiasis

作　　者：徐垚 安东均 冯金鸽 王羊 王金涛[1] 杨林[1] 韩立 赵宝国 张成[1] XU Yao;AN Dong-jun;FENG Jin-ge(Department of Hepatobiliary Surgery,the Central Hospital of Xianyang City Affiliated to Xi'an Jiaotong University,Xianyang 712000,China)

机构地区：[1]西安交通大学附属咸阳市中心医院肝胆外科,陕西咸阳712000

出　　处：《腹腔镜外科杂志》2020年第4期288-292,共5页Journal of Laparoscopic Surgery

摘　　要：目的:比较腹腔镜胆囊切除联合胆总管探查一期缝合鼻胆管引流与T管引流的临床疗效,探讨胆总管一期缝合联合鼻胆管引流的可行性。方法:回顾分析2018年10月至2019年10月130例行腹腔镜胆囊切除、胆总管探查术患者的临床资料。按手术方式分为一期缝合鼻胆管引流组(研究组,n=66)与T管引流组(对照组,n=64),比较两组患者一般资料、手术总时间、术中出血量、术后肛门排气时间、术后首次下床活动时间、术后补液量、术后拔管时间、术后并发症发生率、术后住院时间、住院总费用等数据。结果:两组患者术前一般资料、术前合并症、肝功能、胆总管直径、胆总管结石数量与大小、手术总时间、术中出血量、术后并发症例数差异无统计学意义(P>0.05),两组术后排气时间、术后下床活动时间、术后补液量、术后拔管时间、术后住院时间、住院总费用等差异有统计学意义(P<0.05)。结论:严格掌握手术适应证的前提下行腹腔镜胆囊切除联合胆总管探查一期缝合鼻胆管引流安全、有效;相较T管引流具有加速康复、缩短住院时间、减轻住院费用等优势,值得临床进一步推广。Objective:To compare the clinical efficacy of laparoscopic cholecystectomy(LC)+laparoscopic common bile duct exploration and primary suture(LBEPS)+endoscopic nasobiliary drainage(ENBD)and laparoscopic cholecystectomy+laparoscopic choledocholithotomy and T-tube drainage(LCTD),and to explore the feasibility of LC+LBEPS+ENBD.Methods:Clinical data of 130 patients who underwent LC and laparoscopic common bile duct exploration from Oct.2018 to Oct.2019 were retrospectively analyzed.According to the operation methods,patients were divided into LBEPS+ENBD group(n=66)and T-tube drainage group(n=64).Patients'general information,total operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative ambulation time,postoperative rehydration quantity,postoperative extubation time,postoperative complications,postoperative hospital stay,total hospitalization cost and other indicators were compared between the two groups.Results:There was no significant difference in preoperative general information,preoperative complications,liver function,diameter of common bile duct,number of common bile duct stones,total operation time,intraoperative blood loss or number of postoperative complications between the two groups(P>0.05).There were statistically significant differences in postoperative exhaust time,postoperative out-of-bed activity time,postoperative volume of rehydration fluids needed,postoperative extubation time,postoperative hospitalization time and total hospitalization cost(P<0.05).Conclusions:LC+LBEPS+ENBD is safe and effective under the premise of strict control of surgical indications.Compared with T-tube drainage,it can accelerate the rehabilitation of patients,shorten the hospital stay,reduce the costs of hospitalization,and is worthy of further clinical promotion.

关 键 词：胆总管结石 腹腔镜检查 胆总管探查术 一期缝合 鼻胆管引流 T管引流 

分 类 号：R657.4[医药卫生—外科学]