术中胃镜置鼻胆管在胆总管一期缝合术中的应用

目的 评价术中胃镜放置鼻胆管在胆总管一期缝合术中的应用价值.方法 回顾分析术中胃镜放置鼻胆管一期缝合胆总管42例的临床资料,并与同期40例传统胆总管T管引流术相比较.所有病例术前经选择,术中证实无胆管残余结石、狭窄及胆总管远端通畅,常规放置腹腔引流管.结果 鼻胆管组42例术中放置鼻胆管成功率97.6%(41/42).无一例发生胆漏,拔管时间(6.9±1.9)d、平均住院日(10.1±1.6)d,较T管组分别为(39.4±11.3)d、(15.0±1.9)d]短,差异有显著性意义(P＜0.05).主要不良反应为鼻咽部不适感.结论 术中胃镜放置鼻胆管对预防一期缝合胆总管术后胆漏、胆管狭窄有广泛的应用价值,为胆总管一期缝合提供了安全保证.该方法操作简单、安全、可靠、有效.

The clinical value of intraoperative nasobiliary tube placement with gastroscope in primary suture after choledochotomy

Objective To evaluate the clinical value of intraoperative placement of nasobiliary tube with gastroscope in primary suture after choleduchotomy.Methods A case-control study was performed on 42 patients undergoing this procedure and 40 patients receiving choledochotomy T-tube drainage after surgery in a same period of time.All cases entered according tO the inclusion criteria were verified to be free of retained stones,stricture or obstruction of common bile duct.Abdominal drainage tubes were placed as usual.Results No bile leakage was found in any of the 42 patients receiving the new procedure with a SUCCESS rate of 97.6%(41/42).The number of days taken to extubate intra-choledochus drainage tubes and the length of the postoperative hospital stay were both significantly reduced in the nasobiliary tube drainage patients compared with T-tube drainage controls (P＜0.05).The major adverse effect,if any,was minor discomfort in the pharynx nasalis.Conclusions Intraoperative nasobiliary tube placement is effective in prevention of bile leakage and bile duet stricture in primary suture after choledochotomy.This uncomplicated procedure is safe and reliable with promising clinical application.