鼻胆管引流与T管引流术联合胆总管探查术治疗老年胆总管结石的效果对比

Efficacy and safety of nasobiliary drainage and T-tube drainage combined with common bile duct exploration in the treatment of elderly patients with common bile duct stones

目的比较鼻胆管引流与T管引流术联合胆总管探查术治疗老年胆总管结石的疗效及安全性差异。方法选择2017年2月至2020年1月在浙江中医药大学附属医院接受手术治疗的胆囊结石合并胆总管结石的老年患者82例,按照随机数字表法分为对照组与观察组(均41例)。2组患者均进行腹腔镜下取石手术,观察组在结石取净之后采用鼻胆管引流,对照组在结石取净之后采用T管引流。对比2组的手术相关指标、肝功能指标、术后并发症情况、住院时间以及医疗费用情况。结果2组手术耗时、失血量数据差异无统计学意义(P>0.05)。观察组的术后排气时间、术后下床时间、术后补液量、术后3 d引流量、术后拔管时间均低于对照组(P<0.05)。2组手术前的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素数据差异无统计学意义(P>0.05)。手术后,2组的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素评分均降低(P<0.05),观察组的丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素均低于对照组(P<0.05)。观察组术后的并发症发生率低于对照组(P<0.05)。观察组的住院时间和医疗费用均低于对照组(P<0.05)。结论针对住院治疗的胆总管结石老年患者,采用鼻胆管引流的方法,可有效地改善多种手术指标、缩短术后的恢复时间、提升术后康复的水平。

Objective To explore the efficacy and safety of nasobiliary drainage and T-tube drainage combined with common bile duct exploration in the treatment of elderly patients with common bile duct stones.Methods From February 2017 to January 2020,82 elderly patients with cholecystolithiasis and choledocholithiasis were selected and randomly divided into a control group and an observation group(41 in each group).The observation group was treated with nasobiliary drainage after stone removal, and the control group was treated with T-tube drainage after stone removal.The operation-related indexes, liver function indexes, postoperative complications, hospitalization time and medical expenses of the two groups were compared.Results There was no significant difference in operation time or blood loss between the two groups(P>0.05).The postoperative exhaust time, postoperative ambulation time, postoperative fluid volume, postoperative 3 D drainage volume and postoperative extubation time of the observation group were lower than those of the control group(P<0.05).There was no significant difference in alanine aminotransferase, aspartate aminotransferase or total bilirubin between the two groups before the operation(P>0.05).After the operation, the scores of alanine aminotransferase, aspartate aminotransferase and total bilirubin in the two groups were decreased(P<0.05),and the levels of alanine aminotransferase, aspartate aminotransferase and total bilirubin in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).The hospitalization time and medical expenses of the observation group were lower than those of the control group(P<0.05).Conclusions For hospitalized elderly patients with choledocholithiasis, the use of the nasobiliary drainage method can effectively improve a variety of surgical indicators, shorten the postoperative recovery time, and improve the level of postoperative rehabilitation with reliable safety.