留置鼻胆管联合腹腔镜胆管一期缝合的临床应用研究

Clinical application of endoscopic nasobiliary drainage combined with laparoscopic primary suture of the bile duct

目的 探讨留置鼻胆管联合腹腔镜胆管一期缝合的可行性及优越性.方法 随机将60例胆总管结石患者分为两组,30例行留置鼻胆管联合腹腔镜胆管一期缝合（研究组）,30例行常规腹腔镜胆总管切开取石T管引流术（对照组）.比较两组手术时间、拔除体外胆道引流管（指鼻胆管和T管,以下相同）时间、术后住院时间及并发症等.结果 30例患者成功完成留置鼻胆管联合腹腔镜胆管一期缝合术,研究组手术时间（50±30） min,明显少于对照组（90±30） min;拔管时间（6±2）d及平均住院时间（10 ±2）d,明显少于对照组（25±10）d及（17±2）d,两组差异有统计学意义（P＜0.05）,手术并发症的发生率无显著差异.结论 该术式安全可靠,能够显著缩短手术时间,术后恢复快,术后拔除体外胆道引流管时间明显提前,从而大大缩短了平均住院时间,同时没有增加并发症的发生率.

Objective To explore the feasibility and superiority of endoscopic nasobiliary drain- age combined with laparoscopic primary suture of the bile duct. Methods A total of 60 cases of common bile duct stone patients were randomly divided into two groups. Thirty cases of them underwent nasobiliary drainage combined with laparoscopic primary suture of the bile duct（ Study Group） ,the other 30 cases un- derwent routine laparoscopic choledocholithotomy and T-tube drainage （control group）. Operation time, ex- tubation time, postoperative hospitalization time and complications were compared between the groups. Re- suits Thirty patients were successfully completed the nasobiliary drainage combined with laparoscopic primary suture of the bile duct. Compared with the controls, the operation time （90 ± 30 vs 50 ± 30 min）, extubation time（25 ± 10 vs 6 ±2 d）and average hospitalization time（ 17 ±2 vs 10 ±2 d）in the study group was significantly reduced（ P 〈 0.05 ）. Difference in complication rate was not significantly. Conclusion Nasobiliary drainage combined with laparoscopic primary suture of the bile duct is safe and reliable. It has the advantages of short operation time, rapid postoperative recovery and short extubation time. This may greatly shorten the average hospitalization days,without increasing the incidence of complications.