术前预置鼻胆管引流胆总管探查一期缝合的探讨

目的 探讨术前纤维十二指肠镜下预置鼻胆管引流，胆总管探查术后直接一期缝合的安全性和其临床价值。方法 2004年4月至2007年12月间间，实验组45例胆总管结石并梗阻患者术前3d内镜预置鼻胆管引流，并检测引流前后肝功能变化。手术中胆总管切开、探查、取石后提拉鼻胆管超过切开部位后一期缝合，T管组38例患者胆总管探查后常规T管引流。比较2组患者预后。结果实验组45例术前置鼻胆管成功率100％，肝功能明显好转（P〈0．001），手术时间（95．0±16．0）min，拔管时间（8．9±1．5）d、术后住院时间（9．5±1．3）d，较T管引流组（分别为130．0±25．0min、18．2±1．7d、20．0±1．7d）短，差异有显著性（P〈0．05），且术后无胆漏等并发症。结论 术前预置鼻胆管引流者胆总管探查术中一期缝合术安全可靠、可明显节约手术时间，缩短术后住院天数，值得在临床上推广。

THE CLINICAL SIGNIFICANCE OF THE PRE-OPERATIVE INSTALLATION OF NASOBILIARY DUCT FOR THE PATIENTS RECEIVING PRIMARY SUTURE OF COMMON BILE DUCT

Objective To study the safety and feasibility of the pre-operative installation of endoscopic nasobiliary duct,in primary suture after common bile duct(CBD) in cision and exploration instead of T-tube drainage.Methods From April 2004 to December 2007,45 patients underwent endoscopic nasobiliary duct placement before the operation.Their liver functions were analyzed and other clinic data were compare with those of the 38 patients receiving T-tube drainage in the same period of time.After CBD exploration and stone removal,clamp the tail of nasobiliary duct and pull it into CBD.Then the CBD was interruptedly sutured after confirmation of no residual stones.Results The successful rate of 45 patinets receiving END was 100% their liver functions were markedly improved and no bile leakage happened.The removal time and duration of postoperative hospitalization in the patients receiving END were significantly different from those in the patients receiving T-tube drainage(P<0.05).Conclusion This procedure is a simple,safe method which can prevent occurrence of bile leakage and reduce complications.