术中鼻胆管替代传统T管在腹腔镜胆囊切除+胆总管切开一期缝合的应用效果

Application effect of intraoperative nasobiliary duct replacing traditional T tube in laparoscopic cholecystectomy and choledochotomy with primary suture

目的探讨术中鼻胆管替代传统T管在腹腔镜胆囊切除(LC)+胆总管切开一期缝合的应用价值及临床疗效。方法选取2018年1月—2019年12月汕头大学医学院第二附属医院收治的60例胆总管结石伴胆囊结石患者作为研究对象,按照随机数字表法分为研究组和对照组,每组各30例。研究组行LC+腹腔镜胆总管探查术(LCBDE)+经内镜鼻胆管引流术(ENBD),对照组行LC+LCBDE+T管引流术。比较两组术中和术后情况。结果60例患者均成功实施手术。两组的手术持续时间、术中出血量、引流量及术后胃肠功能恢复时间比较,差异无统计学意义(P>0.05)。研究组的拔引流管时间、术后住院时间短于对照组,研究组的住院费用少于对照组,差异有统计学意义(P<0.05)。所有患者均随访6~10个月,复查发现:两组均未发生胆道狭窄,两组术后胰腺炎发生率比较,差异无统计学意义(P>0.05);研究组血尿淀粉酶升高率、肝功能异常率均低于对照组,差异有统计学意义(P<0.05)。结论鼻胆管在LC+LCBDE中可替代T管引流,能保障胆总管切开一期缝合的安全性,其疗效更加确切、可行。

Objective To investigate the application value and clinical effect of intraoperative nasobiliary duct in replacing traditional T tube in laparoscopic cholecystectomy(LC)+choledochotomy with primary suture.Methods A total of 60 patients with choledocholithiasis simultaneously with cholecystolithiasis who were admitted to the Second Affiliated Hospital of Shantou University Medical College from January 2018 to December 2019 were selected as the research subjects,and were divided into the study group and the control group according to the random number table method,with 30 patients in each group.In the study group,LC+laparoscopic common bile duct exploration(LCBDE)+endoscopic nasobiliary drainage(ENBD)were performed,while in the control group,LC+LCBDE+T tube drainage was performed.The intraoperative and postoperative conditions of the two groups were compared.Results All 60 cases were operated successfully.No significant differences were observed in operative durations,intraoperative blood losses,drainage volumes and postoperative gastrointestinal function recovery times between the two groups(P>0.05).The drainage tube extraction time and postoperative length of hospital stay in the study group were shorter than those in the control group,and the hospitalization cost in the study group was less than that in the control group,and the differences were statistically significant(P<0.05).All patients were followed up for 6 to 10 months,and reexamination showed that:no biliary tract stenosis occurred in the two groups,and no statistically significant difference was observed in the incidences of postoperative pancreatitis between the two groups(P>0.05).The increased rate of amylase in blood and urine and the abnormal rate of liver function in the study group were lower than those in the control group,with statistically significant differences(P<0.05).Conclusion Nasobiliary duct can replace T tube drainage in LC+LCBDE,which can guarantee the safety of primary suture of choledochotomy,and its efficacy is more accurate and feasible.