LC+LCBDE术后一期缝合联合鼻胆管引流治疗胆囊结石合并胆总管结石的临床疗效

Primary suture combined with nasobiliary drainage after laparoscopic cholecystectomy and common bile duct exploration in the treatment of cholecysto-choledocholithiasis

目的探讨腹腔镜胆囊切除联合胆总管探查(LC+LCBDE)术后一期缝合联合鼻胆管引流治疗胆囊结石合并胆总管结石(CCL)的临床疗效。方法采用回顾性队列研究方法,将2013年1月至2016年12月收入成都市第三人民医院接受LC+LCBDE并行胆道引流的92例CCL患者,按手术方式分为一期缝合联合鼻胆管引流组(n=45)和T管引流组(n=47),比较两组患者的手术时间、术中出血量、术后住院时间、胆汁引流时间、腹腔引流管拔除时间、术后并发症发生情况等。结果两组患者的手术时间、术中出血量、腹腔引流管拔除时间及术后并发症发生率比较,差异均无统计学意义(P>0.05)。一期缝合联合鼻胆管引流组术后住院时间明显短于T管引流组[(5.3±1.3)d vs(7.2±2.5)d,P<0.001],该组的胆汁引流时间也明显短于T管引流组[(3.5±1.1)d vs(38.9±6.2)d,P<0.001]。结论在严格掌握手术适应证的情况下,LC+LCBDE术后一期缝合联合鼻胆管引流是安全可行的,缩短了住院时间,提高了患者术后的生活质量,充分体现了加速康复外科理念。在熟练掌握腔镜技术的前提下,该技术值得在临床推广。

objective To explore the effect of primary suture combined with nasobiliary drainage after laparoscopic cholecystectomy and common bile duct exploration（LC＋LCBDE） in the treatment of cholecystocholedocholithiasis（CCL）. Methods Ninety-two patients with CCL who underwent biliary drainage after LC＋LCBDE in the Third People＇s Hospital of Chengdu between Jan. 2013 and Dec. 2016 were retrospectively analyzed. All the patients were divided into primary suture combined with nasobiliary drainage group（n=45） and T-tube drainage group（n=47） according to surgical procedures. The operation duration, intraoperative blood loss, postoperative hospital stay, time of biliary drainage, time of abdominal drainage tube removal, and postoperative morbidity were compared between the two groups（P〈0.05）. Results There were no significant differences of operation duration, intraoperative blood loss, time of abdominal drainage tube removal, and postoperative morbidity between the two groups（P〈0.05）. Compared with T-tube drainage group, the postoperative hospital stay was shorter [（5.3±1.3） d vs（7.2±2.5） d, P〈0.001）] and time to biliary drainage was less [（3.5±1.1） d vs（38.9±6.2） d, P〈0.001] in primary suture combined with nasobiliary drainage group. Conclusion Under strict control of surgical indications, primary suture combined with nasobiliary drainage after LC＋LCBDE is safe and feasible. It helps to shorten postoperative hospital stay, improve the quality of life after surgery, and achieve the purpose of enhanced recovery after surgery. On the basis of mastering the techniques of laparoscopy, it is worthy of clinical promotion.