胆道支架和鼻胆管引流在腹腔镜胆总管探查术后一期缝合中的应用

Application of biliary stent and nasobiliary duct in primary duct closure after laparoscopic common bile duct exploration

目的对比胆道支架和鼻胆管引流在腹腔镜胆总管探查术(LCBDE)后一期缝合中的临床疗效。方法回顾性分析2016年8月-2021年1月在该院行内镜逆行胰胆管造影术(ERCP)取石失败的74例患者的临床资料,分为支架引流组(n=38)和鼻胆管引流组(n=36)。支架引流组ERCP取石失败后放置胆道支架引流,鼻胆管引流组ERCP取石失败后放置鼻胆管引流,两组患者均行腹腔镜胆总管切开取石一期缝合术。比较两组患者手术时间、术后住院时间、术后并发症发生率、术后肠道功能恢复时间、术后胆总管结石复发率和住院时间。结果两组患者胆管缝合方式、手术时间、术中出血量、术后并发症总发生率和住院费用比较,差异均无统计学意义(P>0.05)。鼻胆管引流组术后胆瘘发生率明显低于支架引流组,住院时间明显短于支架引流组,术后肠道功能恢复时间明显长于支架引流组,术后总补液量多于支架引流组,差异均有统计学意义(P<0.05)。结论ERCP取石失败后放置鼻胆管引流,可降低LCBDE术后一期缝合的胆瘘发生率,缩短住院时间,但放置胆道支架引流患者肠道功能恢复更快,补液量更少。因此,在临床操作中,应根据患者具体情况,选择相应的个体化引流方式。

Objective To compare the clinical efficacy of biliary stents and nasobiliary drainage in primary suture after laparoscopic common bile duct exploration(LCBDE).Methods We retrospective analyzed 74 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)stone removal failure from August 2016 to January 2021,then divided them into stent drainage group(n=38)and nasobiliary duct drainage group(n=36).After ERCP stone removal failure in the stent drainage group,biliary stent drainage was placed,while nasobiliary duct drainage was placed after ERCP stone removal failure in the nasobiliary duct drainage group.All these patients underwent laparoscopic choledocholithotomy and primary suture.The operation time,postoperative hospital stay,postoperative complication rate,postoperative intestinal function recovery time,postoperative choledocholithiasis recurrence rate and total hospital stay were compared between the two groups.Results There was no significant difference between the two groups in bile duct suture mode,operation time,intraoperative bleeding,incidence of total postoperative complications and hospitalization expenses(P>0.05).The incidence of postoperative biliary fistula in the nasobiliary duct drainage group was significantly lower than that in the stent drainage group,and the hospital stay was significantly shorter than that in the stent drainage group,the postoperative intestinal function recovery time was significantly longer than that in the stent drainage group,and the total postoperative fluid replacement volume was more than that in the stent drainage group,with statistical significances(P<0.05).Conclusion Placing nasobiliary drainage after ERCP stone removal failure can reduce the incidence of biliary fistula after primary suture after LCBDE and reduce the length of hospital stay.However,patients with biliary stents have faster recovery of intestinal function and less fluid replacement.Therefore,the corresponding individualized drainage mode should be selected according to the specific situation of patients in clinical operation.