经腹顺行鼻胆管置入术在老年细径胆总管结石中的疗效  

Effect of anterograde transabdominal nasobiliary duct placement in elderly patients with fine diameter choledocholithiasis

作　　者：赵硕 王均蒙 罗福宽 胡志恒 赵鸿渐 Zhao Shuo;Wang Junmeng;Luo Fukuan;Hu Zhiheng;Zhao Hongjian(Department of Hepatobiliary Surgery,Shandong Chengwu County People′s Hospital,Heze 274000,China;Department of Gastroenterology,Shandong Chengwu County People′s Hospital,Heze 274000,China)

机构地区：[1]山东省成武县人民医院肝胆外科,菏泽274000 [2]山东省成武县人民医院消化内科,菏泽274000

出　　处：《中国医师进修杂志》2024年第12期1077-1080,共4页Chinese Journal of Postgraduates of Medicine

基　　金：2023年山东省医学会青年人才托举工程(2023_JC_0035)。

摘　　要：目的探讨经腹顺行鼻胆管置入术在老年细径胆总管结石中的应用价值。方法回顾性选择2021年6月至2022年6月在山东省成武县人民医院治疗的老年细径胆总管结石患者60例,均行腹腔镜下胆总管探查术(LCBDE),其中试验组28例采用经腹顺行鼻胆管置入术;对照组32例采用T管引流。比较两组手术指标、术后并发症发生率及总医疗费用、术后患者满意度等。结果两组患者均手术顺利,无中转开腹及死亡病例。试验组胆总管引流管留置时间、术后住院时间短于对照组[(6.46±1.04)d比(33.63±1.19)d、(8.11±0.74)d比(10.38±1.54)d],术后疼痛发生率低于对照组[3.6%(1/28)比21.9%(7/32)],术后患者满意度评分高于对照组[(9.21±0.83)分比(7.56±0.62)分],差异均有统计学意义(P<0.05);两组手术时间、术后活动时间、胃肠功能恢复时间、总医疗费用比较差异无统计学意义(P>0.05)。两组总术后并发症发生率比较差异无统计学意义(P>0.05)。结论经腹顺行鼻胆管置入术在老年细径胆总管结石的治疗中能够缩短胆总管引流管留置时间及住院时间,降低术后并发症发生率,促进快速康复,是一种安全有效的手术方式。ObjectiveTo explore the clinical value of antegrade transabdominal nasobiliary duct placement in the treatment of fine diameter choledocholithiasis in the elderly.MethodsFrom June 2021 to June 2022,60 elderly patients with fine diameter common bile duct stones who were treatment in the Shandong Chengwu County People′s Hospital were enrolled.All patients underwent laparoscopic common bile duct exploration(LCBDE),28 patients in the experimental group were underwent antegrade transabdominal placement of nasal bile ducts,32 patients in the control group were treated with T-tube drainage.The operative index,postoperative complications and total medical expenses,postoperative patient satisfaction were compared between the two groups.ResultsThe operation was successful in both groups,and no conversion to laparotomy or death occurred.The indwelling time of common bile duct drainage,postoperative hospital stay in the experimental group were shorter than those in the control group,the incidence of postoperative pain was lower than that in the control group,the postoperative patient satisfaction was higher than that in the control group:(6.46±1.04)d vs.(33.63±1.19)d,(8.11±0.74)d vs.(10.38±1.54)d,3.6%(1/28)vs.21.9%(7/32),(9.21±0.83)scores vs.(7.56±0.62)scores,there were statistical differences(P<0.05).The surgical time,postoperative activity time,gastrointestinal function recovery time and total medical expenses between the two groups had no statistical differences(P>0.05).The postoperative complications between the two groups had no statistical differences(P>0.05).ConclusionsAnterior transabdominal nasobiliary duct placement can shorten the retention time and hospitalization time of the common bile duct drainage tube,reduce the incidence of postoperative complications,and promote rapid recovery.It is a safe and effective surgical method.

关 键 词：胆总管结石病 老年人 腹腔镜下胆总管探查术 鼻胆管置入术 T管引流 

分 类 号：R657.42[医药卫生—外科学]