腹腔镜胆总管切开取石后鼻胆管引流术

目的:探讨腹腔镜胆总管切开取石后鼻胆管引流的可行性及优越性。方法:随机将56例胆石症患者分为两组,28例行腹腔镜胆总管切开取石后胆总管一期缝合鼻胆管引流术(鼻胆管组),28例行常规腹腔镜胆总管切开取石T形管引流术(T形管组)。比较两组手术时间、拔引流管时间、术后住院时间及并发症等。结果:28例患者成功完成腹腔镜胆总管探查后胆总管一期缝合鼻胆管引流术,鼻胆管组拔管时间(7.6±1.8)d、术后住院时间(9.7±1.6)d,明显少于T形管组(28.6±10.3)d与(20.4±3.6)d,差异有统计学意义(P<0.05),手术时间及并发症的发生率无显著差异(P>0.05)。结论:腹腔镜胆总管切开取石后鼻胆管引流术既能避免Odd is括约肌痉挛引起的胆管压力增高,又能彻底消除拔T形管后引起的胆汁性腹膜炎等并发症,是在胆总管探查术后一种安全实用的引流的新方法。

The nasobiliary duct drainage after laparoscopic choledocholithotomy

Objective:To investigate the feasibility and superiority of the nasobiliary duct drainage after laparoscopic choledocholithotomy.Methods:56 cases with common bile duct stones were divided into two groups.28 patients(nasobiliary duct group,NBD) underwent nasobiliary duct placement during the operation of primary suture after laparoscopic choledocholithotomy,while the other 28 patients(T-tube group,TD) received the traditional T-tube drainage after laparoscopic choledocholithotomy.The difference of operating time,extubation time,postoperative hospital stay and complications between the two groups were studied.Results:The nasobiliary drainage after laparoscopic choledocholithotomy was successfully conducted in 28 cases.The extubation time was(7.6±1.8)d and length of stay was(9.7±1.6)d in the group NBD,which were significantly less than group TD((28.6±10.3)d and(20.4±3.6)d respectively.But the two groups had no significant difference in operating time and complications(P>0.05).Conclusions:The nasobiliary drainage after laparoscopic choledocholithotomy can avoid both the risk of high pressure of biliary duct caused by spasm of Oddi's sphincter and the disadvantage of T-tube drainage after laparoscopic choledocholithotomy,which is a safe and practical operation.