腹腔镜胆总管探查术后一期缝合联合鼻胆管引流的疗效分析

目的比较分析腹腔镜下胆总管探查术后一期缝合联合鼻胆管引流与T管引流治疗胆总管结石的临床疗效及并发症。方法回顾分析2014年2月至2018年6月行腹腔镜胆囊切除(LC)+胆总管探查取石术(LCBDE)的患者共205例,按术后引流方式分为T管引流组(行T管引流,108例)和鼻胆管引流组(行一期缝合联合鼻胆管引流,97例),比较2组患者的手术效果,包括手术时间、术中出血量、术后进食时间、血浆管拔除时间、胆道引流管拔除时间、住院时间;比较2组患者的胆瘘、胆汁性腹膜炎、胆总管残留结石、胆道出血、低钾血症及术后1年胆道狭窄等并发症发生率。结果术后总的并发症发生率组间比较,差异无统计学意义(P>0.05);手术时间、术后进食时间、术中出血量、血浆管拔除时间组间比较,差异无统计学意义(P>0.05);鼻胆管引流组的胆道引流管拔除时间和住院时间短于T管引流组,差异有统计学意义(P<0.05)。结论与留置T管引流相比,腹腔镜胆总管探查术后一期缝合联合鼻胆管引流对机体的生理功能影响更小,引流管拔除时间和住院时间更短,且不会增加手术并发症发生率。

Clinical effect of primary suture combined with nasobiliary drainage after laparoscopic common bile duct exploration

Objective To compare and analyze the clinical efficacy and complications of primary suture combined with nasobiliary drainage and T-tube drainage after laparoscopic common bile duct exploration in the treatment of common bile duct stones.Methods A total of 205 patients underwent laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBDE)from February 2014 to June 2018 were retrospectively analyzed.According to the postoperative drainage methods,the patients were divided into the T-tube drainage group(108 cases received T-tube drainage)and the nasobiliary drainage group(97 cases received primary suture combined with nasobiliary drainage).The surgical effects of the two groups were compared,including operation time,intraoperative blood loss,postoperative feeding time,plasma tube extraction time,biliary drainage tube extraction time,and hospital stay.The incidence of biliary fistula,biliary peritonitis,residual calculi in common bile duct,biliary hemorrhage,hypokalemia and biliary stricture 1 year after operation were compared between the two groups.Results There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).There was no statistically significant difference in operation time,postoperative feeding time,intraoperative blood loss and plasma tube removal time between the two groups(P>0.05).The biliary drainage tube extraction time and hospital stay of the nasobiliary drainage group were shorter than those in the T-tube drainage group,and the differences were statistically significant(P<0.05).Conclusion Compared with indwelling T-tube drainage,primary suture combined with nasobiliary drainage after laparoscopic common bile duct exploration has less impact on physiological functions of the body,and it can shorten the drainage tube removal time and hospital stay without increase of surgical complications.