胆总管一期缝合及鼻胆管引流治疗胆总管结石的疗效与安全性
| 作者: |
1陈伟,
1罗一帆,
1吕品,
1王俊,
1张红辉,
2聂盛丹
1 湖南师范大学附属第一医院/湖南省人民医院肝胆外科，湖南 长沙 410005 2 湖南师范大学附属第一医院/湖南省人民医院临床研究所，湖南 长沙 410005 |
| 通讯: |
吕品
Email: lvpinhn@163.com |
| DOI: | 10.3978/.2018.02.007 |
| 基金: | 湖南省教育厅高校科研经费资助项目（15C0836）。 |
摘要
目的：探讨胆总管一期缝合联合经腹腔顺行放置鼻胆管引流治疗胆总管结石的疗效、安全性。
方法：选择2015年8月—2017年2月湖南省人民医院肝胆外科收治138例胆囊结石合并胆总管结石患者，45例予以腹腔镜胆囊切除、胆总管探查+通过腹腔放置鼻胆管引流并行一期缝合（鼻胆管组），93例予以腹腔镜胆囊切除，胆总管探查+放置T管引流（T管组）。比较两组患者的相关临床指标。
结果：138例患者均顺利实施手术，无严重手术并发症发生。鼻胆管组手术时间、术中出血量及术后第1天胆汁引流量与T管组无统计学差异（均P>0.05），但肠功能恢复时间、胆道引流放置时间、住院所用时间及住院费用，以及术后补液量、第2、3天胆汁引流量均低于T管组（均P<0.05）。两组总并发症发生率无统计学差异（P>0.05），但鼻胆管组恶心、厌食、呕吐等电解质紊乱症状发生率低于T管组（P<0.05）。
结论：鼻胆管引流补充了胆总管一期缝合的适应证，缩短了带管及住院时间，减少了水电解质紊乱，未增加胆汁漏、胆道狭窄等并发症，较T管有一定优势，但需掌握好适应证。
关键词：
胆总管结石病；胆道外科手术；引流术；腹腔镜
方法：选择2015年8月—2017年2月湖南省人民医院肝胆外科收治138例胆囊结石合并胆总管结石患者，45例予以腹腔镜胆囊切除、胆总管探查+通过腹腔放置鼻胆管引流并行一期缝合（鼻胆管组），93例予以腹腔镜胆囊切除，胆总管探查+放置T管引流（T管组）。比较两组患者的相关临床指标。
结果：138例患者均顺利实施手术，无严重手术并发症发生。鼻胆管组手术时间、术中出血量及术后第1天胆汁引流量与T管组无统计学差异（均P>0.05），但肠功能恢复时间、胆道引流放置时间、住院所用时间及住院费用，以及术后补液量、第2、3天胆汁引流量均低于T管组（均P<0.05）。两组总并发症发生率无统计学差异（P>0.05），但鼻胆管组恶心、厌食、呕吐等电解质紊乱症状发生率低于T管组（P<0.05）。
结论：鼻胆管引流补充了胆总管一期缝合的适应证，缩短了带管及住院时间，减少了水电解质紊乱，未增加胆汁漏、胆道狭窄等并发症，较T管有一定优势，但需掌握好适应证。
Efficacy and safety of primary choledochal closure plus nasobiliary drainage in treatment of common bile duct stones
CorrespondingAuthor:LU Pin Email: lvpinhn@163.com
Abstract
Objective: To investigate the efficacy and safety of primary closure of the common bile duct plus nasobiliary drainage via antegrade transabdominal approach in treatment of common bile duct stones.
Methods: One hundred and thirty-eight patients with gallstones and concomitant choledocholithiasis admitted in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital from August 2015 to February 2017 were enrolled. Of the patients, 45 cases underwent laparoscopic cholecystectomy, common bile duct exploration and endoscopic nasobiliary drainage with primary choledochal closure (nasobiliary drainage group), and 93 cases underwent laparoscopic cholecystectomy and common bile duct exploration plus T-tube drainage (T-tube drainage group). The main clinical variables between the two groups of patients were compared.
Results: Operations were successfully completed in all the 138 patients, and no serious surgical complication occurred. In nasobiliary drainage group compared with T-tube drainage group, the operative time, intraoperative blood loss and volume of bile drainage on the first postoperative day showed no significant difference (all P>0.05), but the time to postoperative bowel function recovery, retention of the bile drainage tube, length of hospital stay and hospitalization cost as well as the amount of postoperative fluid infusion, and the volume of bile drainage on the second and third postoperative day were all significantly reduced (all P<0.05). There was no significant difference in overall incidence of postoperative complications between the two groups (P>0.05), but the incidence of symptoms of electrolyte imbalance such as nausea and vomiting in nasobiliary drainage group was significantly lower than that in the T-tube drainage group (P<0.05).
Conclusion: Nasobiliary drainage extends the indications for primary closure of the common bile duct, and can shorten the tube retention time and length of hospital stay, and reduce the fluid and electrolyte disorders, with no increase of complications such as bile leakage and biliary stricture. It has certain superiority to T-tube drainage, but its indications should be followed.
Keywords：
Choledocholithiasis; Biliary Tract Surgical Procedures; Drainage; Laparoscopes
Methods: One hundred and thirty-eight patients with gallstones and concomitant choledocholithiasis admitted in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital from August 2015 to February 2017 were enrolled. Of the patients, 45 cases underwent laparoscopic cholecystectomy, common bile duct exploration and endoscopic nasobiliary drainage with primary choledochal closure (nasobiliary drainage group), and 93 cases underwent laparoscopic cholecystectomy and common bile duct exploration plus T-tube drainage (T-tube drainage group). The main clinical variables between the two groups of patients were compared.
Results: Operations were successfully completed in all the 138 patients, and no serious surgical complication occurred. In nasobiliary drainage group compared with T-tube drainage group, the operative time, intraoperative blood loss and volume of bile drainage on the first postoperative day showed no significant difference (all P>0.05), but the time to postoperative bowel function recovery, retention of the bile drainage tube, length of hospital stay and hospitalization cost as well as the amount of postoperative fluid infusion, and the volume of bile drainage on the second and third postoperative day were all significantly reduced (all P<0.05). There was no significant difference in overall incidence of postoperative complications between the two groups (P>0.05), but the incidence of symptoms of electrolyte imbalance such as nausea and vomiting in nasobiliary drainage group was significantly lower than that in the T-tube drainage group (P<0.05).
Conclusion: Nasobiliary drainage extends the indications for primary closure of the common bile duct, and can shorten the tube retention time and length of hospital stay, and reduce the fluid and electrolyte disorders, with no increase of complications such as bile leakage and biliary stricture. It has certain superiority to T-tube drainage, but its indications should be followed.