鼻胆管引流与十二指肠乳头导管扩张在腹腔镜胆囊管微切开胆总管一期缝合术中的疗效比较

Comparison of curative effect of nasobiliary drainage and duodenal papillary duct expansion in laparoscopic cystic duct microincision with common bile duct primary suture

目的 探讨腹腔镜胆囊管微切开分别进行术中联合内镜留置鼻胆管引流与十二指肠乳头导管扩张后胆总管一期缝合的疗效。方法 选取我院收治的胆总管结石合并胆囊结石患者83例,均行腹腔镜下微切开胆囊管进行胆道镜取石,其中43例同期术中十二指肠镜留置鼻胆管引流后胆总管一期缝合(鼻胆管组),40例同期术中胆道扩张导管扩张十二指肠乳头后胆总管一期缝合(导管扩张组)。比较两组患者术中出血、手术时间;丙氨酸转氨酶、血淀粉酶、总胆红素、术后第一日腹腔引流量;腹腔引流管拔管时间,住院时间;术后急性胰腺炎、残留结石及胆漏。结果 所有患者均顺利完成手术,两组手术时间、术中出血量差异有统计学意义(P<0.05);引流管拔管时间、术后第一日腹腔引流量、术后丙氨酸转氨酶、胆红素、血淀粉酶、住院时间等指标比较差异均无统计学意义(P>0.05);鼻胆管组术后3例急性胰腺炎,2例胆漏,1例残留结石;导管扩张组术后1例急性胰腺炎,2例胆漏,无残留结石,两组并发症比较差异无统计学意义(P>0.05)。结论 腹腔镜微切开胆囊管胆道镜取石行胆总管一期缝合,采用鼻胆管引流或导管扩张均能达到解除胆道梗阻、通畅引流、减少胆总管创伤、维护胆总管解剖生理特性目的。

Objective To compare the curative effect of the intraoperative endoscopic indwelling nasobiliary drainage and duodenal papillary duct expansion in laparoscopic microincision of cystic duct with primary suture of common bile duct.Methods A total of 83 patients with common bile duct stones and cholecystolithiasis treated in our hospital were selected. All patients underwent laparoscopic microincision of cystic duct for choledochoscopy. After primary suture of common bile duct, 43 patients were treated with duodenal endoscopic nasobiliary drainage(nasobiliary drainage group) while another 40 patients were treated with duodenal papillary duct expansion(duct expansion group). The operation time, intraoperative hemorrhage, alanine aminotransferase,, blood amylase, total bilirubin, intraperitoneal drainage volume on the first day after surgery, time of extubation of abdominal drainage tube, and hospital stay were compared between the two groups. It was also recorded whether there was postoperative acute pancreatitis, bile leakage and residual stones.Results All patients successfully completed the operation. There were significant differences in operation time and intraoperative hemorrhage between the two groups(P<0.05). There was no significant difference in time of extubation of abdominal drainage tube, hospital stay and intraperitoneal drainage on the first day after surgery, blood amylase, alanine aminotransferase, and total bilirubin(P>0.05). There were 3 cases of acute pancreatitis, 2 cases of bile leakage and 1 case of residual calculi in the nasobiliary drainage group. There were 1 case of acute pancreatitis, 2 cases of bile leakage and no residual stones in the duct expansion group. There was no significant difference in complications between the two groups(P>0.05).Conclusion Both nasobiliary drainage and duct dilation can relieve the biliary obstruction, smooth the drainage, and reduce the common bile duct trauma. Thus, the anatomical and physiological characteristics of the common bile duct can be maintained.