不同外引流术治疗胆囊结石合并胆总管结石的疗效比较

Comparison of Curative Effects of Different External Drainage Methods in Patients With Cholecystolithiasis and Choledocholithiasis

目的比较胆总管一期缝合胆道置管与鼻胆管两种不同胆管外引流方式在胆囊结石合并胆总管结石中的临床疗效。方法回顾性分析2016年4月—2019年4月医院187例胆囊结石合并胆总管结石患者的临床资料。按手术方式分为A组(109例):胆总管一期缝合+经胆囊管胆道置管引流组,B组(78例):胆总管一期缝合+经腹腔顺行放置鼻胆管引流组。观察两组两组手术时间、术后住院时间、术后4 d血清总胆红素、恢复正常生活时间;导管有无滑脱、堵塞、自行拔管和胆瘘情况,记录两组1~5 d的胆汁引流量变化。结果A组手术时间明显短于B组(P<0.05);术后,两组住院时间、4 d后血清总胆红素、恢复正常生活时间以及导管滑脱、堵塞等情况比较,差异无统计学意义(P>0.05),除滑落外,A组堵塞、自行拔管、胆瘘更少;术后1~4 d,两组胆汁引流量比较,差异无统计学意义(P>0.05),第5 d,A组明显少于B组(P<0.05)。结论两种管外引流方式均可实现胆道引流目的,但在一定程度上,胆总管一期缝合经胆囊管胆道置管引流手术时间更短,更为微创。

Objective To compare the clinical efficacy of two different bile duct drainage methods for primary bile duct suture and nasal bile duct drainage in cholecystolithiasis combined with choledocholithiasis.Methods The clinical data of 187 patients with cholecystolithiasis combined with choledocholithiasis in our hospital from April 2016 to April 2019 were retrospectively analyzed.According to the surgical method,they were divided into group A(109 cases):common bile duct suture+bile duct drainage group,group B(78 cases):common bile duct suture+nasal bile duct drainage through the abdominal cavity.The operation time,postoperative hospital stay,serum total bilirubin,recovery of normal life time,catheter slippage,blockage,self extubation and bile fistula were observed in the two groups.The changes of bile drainage volume in 1~5 days were recorded.Results The operation time in group A was significantly shorter than that in group B(P<0.05).There was no significant difference in the length of hospital stay,total serum biliary redness,normal life time,catheter slippage,and blockage in the two groups after surgery.Significance(P>0.05),with the exception of slippage,group A had fewer blockages,self-extubation,and less bile fistulas;there was no significant difference in bile drainage between the two groups after 1~4 days(P>0.05);Group A was significantly less than group B(P<0.05).Conclusion Bile duct drainage can be achieved with two extratubular drainage methods,but to a certain extent,the primary bile duct suture through the cystic duct and bile duct drainage is shorter and less invasive.