胆总管切开探查后几种不同引流方式的比较

Comparison of different common bile duct drainage ways after choledochotomy and exploration

目的分析常规T管引流、经T管放置导管回输胆汁和放置鼻胆管并行胆总管一期缝合等三种不同方法的并发症发生情况、住院时间等的差异。方法常规T管引流348例,经T管放置导管回输胆汁113例,经十二指肠镜行鼻胆管引流术,胆总管切开探查后一期缝合55例。分析比较三组患者的并发症发生情况(电解质紊乱、胆漏、腹膜炎等)、住院时间和住院费用的差异,并行统计学分析。结果行鼻胆管引流术及胆总管一期缝合者,术后并发症较另外两组明显减少,住院时间最短,与前两者相比差异有统计学意义(P<0.01)。常规T管引流组,术后并发症较另外两组明显增多,住院时间最长(P<0.01)。结论胆总管切开后常规放置T管并发症发生率相对较高,而且住院时间长;经T管放置导管回输胆汁减少了胆汁丢失的并发症。经十二指肠镜放置鼻胆管、一期缝合胆总管消除了T管并发症,住院时间最短。

Objective To exploration and analyze the difference in complications and haspital stay a- mong three different groups （common ＂T＂ robe drainage,transferring back the bile through a thin robe which tram - through the ＂T＂ tube,and placing a nasobiliary tube with primary suture of the common bile duct.Methods The operation of common ＂T＂ robe was to place in 348 cases,to transfer back the bile through a tube which tram - through the ＂T＂ tube in 113 cases,and to place the nasobiliary tube through the endcsmpe for bile drainage,and suture the common bile duct after chledochotomy and exploration in 55 eases. The difference in complications and the hospital stay among three groups was compared. Results The incidence of complications in the group of nasobiliary tube was significantly decreased and the hospital stay was shortened as compared with those in the other two （ P 〈0.01）.In the group of common ＂T＂ robe drainage,the incidence of complications was significantly increased and the hospital stay was significantly prolonged as compared with these in the other two groups （ P 〈 0.01）. Conclusion The common method of ＂T＂ ＂cube drainage has costively higher complications. The hospital stay is longer than others. To transfer back bile through thin tube reduced the complications from bile loss. The method of plating the nasdoiliary tube and primary suturing the common bile duct eliminates the complication of ＂T＂ robe and shortens the hospital stay.