术中鼻胆管引流术在胆总管结石合并胆囊结石一期缝合术中的应用

Application of Intraoperative endoscopic nasobiliary drainage over primary suture of common bile duct for choledocholithiasis combined with cholecystolithiasis

目的探究术中鼻胆管引流术在胆总管结石合并胆囊结石一期缝合术中的应用。方法回顾分析2014年1月至2017年12月经确诊的胆总管结石合并胆囊结石患者76例资料,根据治疗方式的不同,分为研究组(LC+LCBDE+术中ENBD+CBD一期缝合)和对照组(术前ERCP+LC),每组各38例,采用统计学软件SPSS 24. 0进行统计学分析,术中术后情况比较采用(均数±标准差)表示,采用独立t检验;术后并发症、ASA分级组间比较采用卡方检验,P <0. 05表示差异有统计学意义。结果研究组手术时间、住院时间显著少于对照组,P <0. 001;研究组手术成功率为100%,显著高于对照组89. 5%,P=0. 040;研究组患者平均手术费用显著少于对照组[(1. 3±0. 1)万元vs.(1. 6±0. 1)万元,P <0. 001)]。两组并发症的发病率差异无统计学意义。结论 LC+LCBDE+术中ENBD+CBD一期缝合术较术前ERCP+LC治疗胆总管结石合并胆囊结石,其治疗效果更优。

Objective To investigate the application of Intraoperative endoscopic nasobiliary drainage over primary suture of common bile duct for choledocholithiasis combined with cholecystolithiasis. Methods From January 2014 to December 2017, 76 patients with choledocholithiasis combined with cholecystolithiasis were included in this study. According to the different treatment methods, the patients were divided into study group （LC＋LCBDE＋intraoperative ENBD＋primary closure of CBD） and control group （preoperative ERCP＋LC）, 38 cases in each group. Statistical analysis was carried out with SPSS 24.0 . The intraoperative and post-operative situations were compared by means ±s and independent t -test. The data of postoperative complications and ASA grading group was analyzed by Chi square. P 〈0.05 showed statistically significant difference. Results The operative time and length of stay in the study group were significantly less than those in the control group （ P 〈0.001）. The success rate of operation in the study group was significantly higher than that in the control group （100% vs. 89.5%, P =0.040）. The average surgical expenses in the study group was significantly less than that in the control group. [（1.3± 0.1） ten thousand RMB vs.（1.6±0.1）ten thousand RMB, P 〈0.001]. No significant difference in the incidence of complications between the two groups was found. Conclusion LC＋LCBDE＋intraoperative ENBD＋primary closure of CBD is more effective than preoperative ERCP＋LC in the treatment of common bile duct stones combined with gallbladder stones.