腹腔镜胆总管探查鼻胆管引流与T管引流的疗效比较

发布时间：2018-04-26 01:37

本文选题：腹腔镜胆道探查术 + 胆总管结石　；参考：《中国内镜杂志》2016年05期

【摘要】：目的比较分析腹腔镜胆总管探查取石术后鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石(CBDS)的临床疗效。探讨腹腔镜胆总管探查、一期缝合并经腹置鼻胆管引流术的临床经验。方法回顾性分析成都市第二人民医院肝胆胰外科2014年5月-2015年5月55例胆囊结石合并CBDS患者分别行腹腔镜下胆囊切除术+胆总管探查+一期缝合术+经腹置鼻胆管引流30例(鼻胆管组)及腹腔镜下胆囊切除术+胆总管探查+T管引流25例(T管组)的临床资料,对比分析两组患者的临床治疗情况。结果两组手术时间、术后住院时间、胃肠功能恢复时间和胆道引流管留置时间差异有统计学意义(P0.05),鼻胆管组更具优势;术中出血量,术后第1天胆汁引流量差异无统计学意义(P0.05);术后第2和3天胆汁引流量差异有统计学意义(P0.05),T管组优势更明显。T管组术后并发症共11例(44.0%),鼻胆管组共10例(33.3%),差异无统计学意义(P0.05),但术后水、电解质紊乱致厌食、恶心等消化道症状几乎均由T管引流造成,两组差异有统计学意义(P0.05)。结论腹腔镜胆总管探查取石术后鼻胆管引流扩大了胆总管一期缝合的适应证,避免了T管引流的一系列弊端,并未增加胆漏、结石残留及胆道狭窄等并发症发生率,体现了微创外科技术的优越性,适应证范围内治疗胆囊结石合并CBDS安全、有效。
[Abstract]:Objective to compare the clinical effects of nasobiliary drainage and T tube drainage after laparoscopic choledocholithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis (CBDS). To explore the clinical experience of laparoscopic common bile duct exploration, primary suture and transabdominal nasobiliary drainage. Methods from May 2014 to May 2015, 55 cases of cholecystolithiasis complicated with CBDS in Chengdu second people's Hospital were retrospectively analyzed. The patients underwent laparoscopic cholecystectomy with exploration of common bile duct suture through abdominal nasobiliary duct. Clinical data of 30 cases of nasobiliary drainage (nasobiliary group) and 25 cases of T-tube drainage under laparoscopic cholecystectomy. The clinical treatment of the two groups was compared and analyzed. Results there were significant differences in operation time, postoperative hospitalization time, gastrointestinal function recovery time and biliary drainage tube indwelling time between the two groups (P 0.05). There was no significant difference in bile drainage flow on the first day after operation (P 0.05), but on the 2nd and 3rd day after operation, the difference of bile drainage flow was statistically significant. There were 11 cases of postoperative complications in T tube group (n = 11) and 10 cases in nasal bile duct group (n = 10) with no difference. P 0.05, but postoperative water, Anorexia, nausea and other gastrointestinal symptoms caused by electrolyte disturbance were almost caused by T-tube drainage. The difference between the two groups was statistically significant (P 0.05). Conclusion the nasobiliary drainage after laparoscopic choledocholithotomy has enlarged the indication of primary suture of common bile duct, avoided a series of disadvantages of T-tube drainage, and did not increase the incidence of complications such as bile leakage, residual stone and stricture of bile duct. It shows the superiority of minimally invasive surgical technique and is safe and effective in the treatment of cholecystolithiasis with CBDS.
【作者单位】：遵义医学院研究生院;四川省成都市第二人民医院肝胆胰外科;
【基金】：2014年成都市卫生局一般科研项目(No:2014085)
【分类号】：R657.4

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