鼻胆管引流在腹腔镜胆总管切开一期缝合中的临床应用

Clinical application of endoscopic nasobiliary drainage in laparoscopic common bile duct exploration and primary suture

目的探讨术中留置鼻胆管引流在腹腔镜下胆总管一期缝合中的价值和意义。方法 62例胆总管结石患者随机分为两组,研究组行腹腔镜胆总管切开（LCBDE）一期缝合＋内镜下鼻胆管引流术（ENBD）,而对照组行腹腔镜胆总管切开、胆道探查＋T管引流术,比较两组的临床效果。结果两组患者均成功实施腹腔镜手术,无1例病患中转开放手术。研究组术后肠道功能恢复时间、拔除引流管时间和术后平均住院时间等均少于对照组,两组资料比较,差异具有统计学意义（P〈0.05）。而手术持续时间、术中总出血量及手术后并发症如胆漏、胆道残余结石和胆道狭窄等的发生率等两组患者比较差异无统计学意义（P〉0.05）。所有患者出院后均随访6~12个月,平均9个月,没有发现胆道狭窄、胆管残余结石等并发症。结论鼻胆管引流能有效引流胆汁,减轻胆道压力,保障腹腔镜胆总管切开一期缝合的安全,缩短住院时程,提升患者满意度,临床应用安全、有效、可行。

Objective To explore the clinical application of endoscopic nasobiliary drainage in laparoscopic com- mon bile duct exploration and primary suture. Methods Sixty-two cases of common bile duet stone patients were di- vided into two groups randomly. Study Group underwent nasobiliary drainage associated with laparoscopic common bile duct exploration and primary suture, while control group received laparoscopic common bile duct exploration and T-tube drainage. The clinical data were analyzed between the two groups. Results The operation were success- fully completed by laparoscope in both groups. Compared with the controls, the recovery time of intestinal function, the extubation time and the postoperative hospitalization time in the study group was significantly reduced （P 〈 0.05）. There were no significantly difference in the operation time, the intraoperative blood loss, and the incidence of bile leakage between the two groups （P 〉 0.05）. All the patients were fellow up for 6-12 months （average, 9 months）, no complications such as biliary stricture and residual stones were found. Conclusion Nasobiliary drainage is feasible, safe and effective. It can drain away bile effectively, reduce biliary pressure, ensure the safety of the primary suture, improve patient＇s satisfaction and shorten hospital stay.