腹腔镜下胆囊切除术联合腹腔镜下胆总管探查术治疗胆囊结石合并胆总管结石患者疗效研究

Combination of laparoscopic cholecystectomy and laparoscopic common bile duct exploration in treatment of patients with gallbladder and common bile duct stones:Is the nasobiliary drainage superior to T-tube drainage?

目的探讨腹腔镜下胆囊切除术(LC)联合腹腔镜下胆总管探查术(LCBD)治疗胆囊结石合并胆总管结石患者的疗效。方法2018年3月~2022年5月我院诊治的胆囊结石合并胆总管结石患者85例,均接受LC联合LCBDE手术治疗,其中42例观察组采用经鼻胆管引流,另43例对照组采用T管引流。应用胃肠道生活质量指数(GIQLI)问卷评估生活质量。结果观察组引流管拔除时间和医疗花费分别为(5.6±1.8)d和(3.5±0.5)万元,均显著短于或少于对照组[分别为(50.5±6.8)d和(3.9±0.7)万元,P<0.05];在术后1 w,观察组血清ALT和AST水平分别为(37.1±14.6)U/L和(36.7±16.8)U/L,均显著低于对照组【分别为(79.7±13.8)U/L和(53.5±14.7)U/L,P<0.05】;在术后1个月,观察组GIQLI评分为(98.5±3.3)分,显著高于对照组【(81.4±3.9)分,P<0.05】;术后观察组肝功能异常发生率为40.5%,显著低于对照组的65.1%(P<0.05),而两组胆漏、胰腺炎、胆总管结石残留和出血发生率比较,无显著性差异(P>0.05)。结论在采用LC联合LCBDE术治疗胆囊结石合并胆总管结石患者时放置鼻胆管引流可能是一种技术进步,可免除T管引流对患者术后生活质量的干扰,对维持正常的消化功能也有积极的意义。

Objective The aim of this study was to select a relatively good biliary drainage for patients with cholecystolithiasis and choledocholithiasis undergoing surgical operation.Methods 85 patients with gallbladder and common bile duct stones were encountered in our hospital between March 2018 and May 2022,and all received laparoscopic cholecystectomy(LC)and laparoscopic common bile duct exploration(LCBD)combination operation.After removal of the gallbladders and the stones,the nasobiliary drainage was conducted in the observation group(n=42)and the T-tube drainage was completed in the control group(n=43).The gastrointestinal quality of life index(GIQLI)was evaluated by questionnaire.Results The drainage tube removal time and medical cost in the observation group were(5.6±1.8)days and(35.0±5.0)thousand yuan,both significantly shorter or less than[(50.5±6.8)days and(39.0±7.0)thousand yuan,P<0.05];at day 7 after operation,serum ALT and AST levels in the observation group were(37.1±14.6)U/L and(36.7±16.8)U/L,both much lower than[(79.7±13.8)U/L and(53.5±14.7)U/L,respectively,P<0.05]in the control;one month after operation,the GIQLI score in the observation group was(98.5±3.3),significantly higher than[(81.4±3.9),P<0.05]in the control;post-operationally,the incidence of abnormal liver function tests in the observation group was 40.5%,much lower than 65.1%(P<0.05)in the control,while there were no significant differences as respect to the bile leakage,pancreatitis,residual bile duct stones and bleeding occurrence between the two groups(P>0.05).Conclusion The placement of nasobiliary drainage during the LC and LCBDE operation in the treatment of patients with gallbladder and common bile duct stones might be a technical innovation,which could improve the quality of life after operation.