腹腔镜胆总管探查鼻胆管引流与T管引流的疗效比较*

目的比较分析腹腔镜胆总管探查取石术后鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石(CBDS)的临床疗效。探讨腹腔镜胆总管探查、一期缝合并经腹置鼻胆管引流术的临床经验。方法回顾性分析成都市第二人民医院肝胆胰外科2014年5月-2015年5月55例胆囊结石合并CBDS患者分别行腹腔镜下胆囊切除术+胆总管探查+一期缝合术+经腹置鼻胆管引流30例(鼻胆管组)及腹腔镜下胆囊切除术+胆总管探查+T管引流25例(T管组)的临床资料,对比分析两组患者的临床治疗情况。结果两组手术时间、术后住院时间、胃肠功能恢复时间和胆道引流管留置时间差异有统计学意义(P0.05),鼻胆管组更具优势;术中出血量,术后第1天胆汁引流量差异无统计学意义(P0.05);术后第2和3天胆汁引流量差异有统计学意义(P0.05),T管组优势更明显。T管组术后并发症共11例(44.0%),鼻胆管组共10例(33.3%),差异无统计学意义(P0.05),但术后水、电解质紊乱致厌食、恶心等消化道症状几乎均由T管引流造成,两组差异有统计学意义(P0.05)。结论腹腔镜胆总管探查取石术后鼻胆管引流扩大了胆总管一期缝合的适应证,避免了T管引流的一系列弊端,并未增加胆漏、结石残留及胆道狭窄等并发症发生率,体现了微创外科技术的优越性,适应证范围内治疗胆囊结石合并CBDS安全、有效。

Comparison of efficacy of nasobiliary drainage and T tube drainage after laparoscopic common bile duct exploration*

Objective To analyze the clinical efficacy of laparoscopic common bile duct exploration with nasobiliary drainage and T tube drainage which the gallstone with common bile duct stones was treated. To explore the clinical experience of laparoscopic common bile duct exploration, primary suture and nasobiliary drainage. Methods 55 cases of gallbladder stones combined with common bile duct stones were divided into two groups from May 2014 to May 2015. 30 cases in nasobiliary drainage group were treated with laparoscopic cholecystectomy + common bile duct exploration + primary suture + nasobiliary drainage, 25 cases in T tube drainage group were treated by laparoscopic cholecystectomy + common bile duct exploration + T tube drainage. Then analyze the clinical efficacy comparatively. Results There was significant difference in operation time, hospitalization time, recovery time of gastrointestinal function, and time of recovery of gastrointestinal function, and the time difference between the two groups (P <0.05), the nasalbile duct group has a better advantage. There was no significant difference in the volume of blood loss during the operation, the first day after operation, the bile flow volume was not statistically significant (P >0.05), there were significant differences in bile drainage volume between second and three days after operation (P <0.05), T tube group advantage is more obvious. There were 11 cases (44.0%) in T tube group, 10 cases (33.3%) in nasal bile duct group, the difference was not statistically significant (P > 0.05). But the Water and electrolyte disorders caused by anorexia, nausea and other gastrointestinal symptoms are almost caused by T tube drainage, the difference between the two groups was statistically significant (P < 0.05). Conclusion Laparoscopic common bile duct exploration and postoperative drainage of the bile duct to expand the indication of primary suture of the common bile duc, to avoid a series of drawbacks of T tube drainage, and it was not increase the incidence of complications such as bile leakage, stone and biliary stricture. The advantages of minimally invasive surgical techniques were embodied, it was safe and effective in the treatment of common bile duct stones.