顺行ENBD联合LCBDE及一期缝合术治疗胆囊结石合并胆总管结石的临床研究  

Clinical study of anterograde endoscopic nasobiliary drainage combined with laparoscopic common bile duct exploration and one-stage suture in the treatment of cholecystolithiasis complicated with choledocholithiasis.

作　　者：张华秦 吴海滨[2] 薛飞 王锦江[1] ZHANG Hua-qin;WU Hai-bin;XUE Fei;WANG Jin-jiang(Department of General Surgery,Yan'an People's Hospital,Yan'an 716000,Shaanxi,CHINA;Department of Hepatobiliary Surgery,Yan'an People's Hospital,Yan'an 716000,Shaanxi,CHINA)

机构地区：[1]延安市人民医院普外科,陕西延安716000 [2]延安市人民医院肝胆外科,陕西延安716000

出　　处：《海南医学》2022年第11期1411-1414,共4页Hainan Medical Journal

摘　　要：目的探究顺行内镜下鼻胆管引流术(ENBD)联合腹腔镜胆总管探查术(LCBDE)及一期缝合术治疗胆囊结石合并胆总管结石的疗效及安全性。方法回顾性分析延安市人民医院2018年4月至2020年4月收治的50例胆囊结石合并胆总管结石患者的临床资料,按照手术方式的不同将患者分为对照组和观察组各25例。对照组患者行LCBDE联合腹腔镜胆囊切除术+T管引流术,观察组患者行顺行ENBD联合LCBDE+一期缝合术。比较两组患者的手术时间、术中出血量、住院时间、治疗费用、术后并发症、肛门排气时间及治疗的效果。结果观察组患者的手术时间、术中出血量、住院时间、治疗费用、肛门排气时间分别为(132.33±17.92)min、(23.62±6.91)mL、(9.61±2.54)d、(0.52±0.15)万元、(31.69±9.62)h,明显短于或低于对照组的(163.62±17.80)min、(29.14±8.85)mL、(11.40±3.41)d、(0.64±0.12)万元、(45.63±13.42)h,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为96.00%,明显高于对照组的76.00%,差异有统计学意义(P<0.05);观察组患者的术后并发症发生率为8.00%,明显低于对照组的28.00%,差异有统计学意义(P<0.05)。结论胆囊结石合并胆总管结石患者应用顺行ENBD联合LCBDE+一期缝合术能有效提高手术治疗的效果,降低术后并发症发生率,值得临床推广。Objective To explore the efficacy and safety of anterograde endoscopic nasobiliary drainage(ENBD)combined with laparoscopic common bile duct exploration(LCBDE)and one-stage suture in the treatment of cholecystolithiasis complicated with common bile duct stones.Methods The clinical data of 50 patients with cholecystolithiasis complicated with choledocholithiasis treated in Yan’an People’s Hospital from April 2018 to April 2020 were analyzed retrospectively.According to different surgical methods,the patients were divided into a control group and a study group,with 25 patients in each group.Patients in the control group underwent LCBDE combined with laparoscopic cholecystectomy+T-tube drainage,and patients in the study group underwent anterograde ENBD combined with LCBDE+one-stage suture.The operation time,intraoperative bleeding,length of hospital stay,treatment cost,postoperative complications,anal exhaust time,and treatment effect were compared between the two groups.Results The operation time,intraoperative bleeding,length of hospital stay,treatment cost,and anal exhaust time in the study group were(132.33±17.92)min,(23.62±6.91)mL,(9.61±2.54)d,(0.52±15)×10^(4)yuan,and(31.69±9.62)h,which were significantly shorter or lower than(163.62±17.80)min,(29.14±8.85)mL,(11.40±3.41)d,and(64±12)×10^(4)yuan,and(45.63±13.42)h in the control group(P<0.05).The total effective rate of the study group was 96.00%,which was significantly higher than 76.00% of the control group(P<0.05).The incidence of postoperative complications in the study group was 8.00%,which was significantly lower than 28.00% in the control group(P<0.05).Conclusion The application of anterograde ENBD combined with LCBDE and one-stage suture in patients with cholecystolithiasis complicated with choledocholithiasis can effectively improve the effect of surgical treatment and reduce the incidence of postoperative complications,which is worthy of clinical promotion.

关 键 词：胆囊结石 胆总管结石 顺行内镜下鼻胆管引流术 腹腔镜胆总管探查术 一期缝合 腹腔镜 疗效 

分 类 号：R657.42[医药卫生—外科学]