腹腔镜胆囊切除术中联合十二指肠镜下鼻胆管引流对胆汁引流量及肠胃道功能恢复的影响

Effect of combined nasobiliary drainage under duodenoscope during laparoscopic cholecystectomy on bile drainage and gastrointestinal function recovery

目的探讨腹腔镜胆囊切除术中联合十二指肠镜下鼻胆管引流对胆汁引流量及肠胃道功能恢复的影响。方法回顾性分析2019年1月至2022年12月于忻州市人民医院进行腹腔镜胆囊切除术的100例患者为研究对象,根据引流方式不同分为对照组和观察组,每组各50例,两组患者均行腹腔镜胆囊切除术。对照组采用腹腔镜T管引流术,观察组采用十二指肠镜下鼻胆管引流。比较两组胆汁引流量、肠胃道功能恢复情况、胆囊功能及术后并发症发生情况。结果观察组术后1、2、3 d的胆汁引流量分别为(214.62±115.62)、(226.42±138.69)、(203.47±142.25)mL,均低于对照组[(264.42±100.65)、(312.65±131.25)、(264.79±122.47)mL],差异均有统计学意义(P<0.05)。术后,观察组胃泌素、胃动素、细胞二胺氧化酶水平分别为(62.52±3.84)ng/mL、(60.04±6.28)ng/L、(2.77±0.84)IU/L,均低于对照组[(73.25±4.28)ng/mL、(68.32±6.94)ng/L、(4.15±1.16)IU/L],差异均有统计学意义(P<0.05)。术后,观察组胆囊壁厚度、空腹胆囊容积分别为(2.72±0.58)mm、(21.16±5.13)mm 3,均低于对照组[(3.66±0.73)mm、(24.58±5.47)mm 3],胆囊收缩率为(72.76±6.24)%,高于对照组[(62.36±5.96)%],差异均有统计学意义(P<0.05)。观察组术后并发症发生率为8.00%,较对照组(26.00%)低,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中联合十二指肠镜下鼻胆管引流,其胆汁引流量较常规引流方式低,但对机体的刺激性较小,且不会对肠胃道功能恢复和胆囊功能造成过多影响,有利于减少术后并发症发生的风险,值得推广。

Objective To explore the effect of combined nasobiliary drainage under duodenoscope during laparoscopic cholecystectomy on bile drainage and gastrointestinal function recovery.Methods A retrospective analysis of 100 patients who underwent laparoscopic cholecystectomy in Xinzhou People's Hospital from January 2019 to December 2022 were carried out,and were divided into control group and observation group according to different drainage methods,with 50 cases in each group.Both groups were treated with laparoscopic cholecystectomy.The control group used laparoscopic T-tube drainage,and the observation group used endoscopic nasobiliary drainage.The bile drainage volume,recovery of gastrointestinal function,gallbladder function,and postoperative complications were compared between the two groups.Results The bile drainage volume of the observation group were(214.62±115.62),(226.42±138.69)and(203.47±142.25)mL at 1,2,and 3 days after operation,respectively,which were lower than those of the control group[(264.42±100.65),(312.6±131.25)and(264.79±122.47)mL],the differences were statistically significant(P<0.05).After operation,the levels of Gastrin,motilin,and diamine oxidase in the observation group were(62.52±3.84)ng/mL,(60.04±6.28)ng/L and(2.77±0.84)IU/L,respectively,which were lower than those in the control group[(73.25±4.28)ng/mL,(68.32±6.94)ng/L and(4.15±1.16)IU/L],the differences were statistically significant(P<0.05).After operation,the gallbladder wall thickness and fasting gallbladder volume in the observation group were(2.72±0.58)mm and(21.16±5.13)mm 3,respectively,which were lower than those in the control group[(3.66±0.73)mm and(24.58±5.47)mm 3],the gallbladder contraction rate was(72.76±6.24)%,which was higher than that in the control group[(62.36±5.96)%],and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 8.00%,which was lower than that in the control group(26.00%),and the difference was statistically significant(P<0.05).Conclusion The nasobiliary drainage combined with duodenoscopy during laparoscopic cholecystectomy has lower bile drainage flow than the conventional drainage method,but it has less irritation to the body,and will not have too much impact on the recovery of gastrointestinal function and gallbladder function,which is conducive to reducing the risk of postoperative complications,and is worthy of promotion.