术前置鼻胆管在腹腔镜胆总管探查一期缝合的应用研究
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王永恒

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A study on preoperative placement of ENBD tube in the application of laparoscopic common bile duct exploration with primary suture
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    摘要:

    目的:探讨术前置鼻胆管在腹腔镜胆总管探查一期缝合替代T管引流术的可行性。
    方法:回顾性分析因胆总管结石行腹腔镜胆总管探查术l02例的临床资料,比较术前置鼻胆管、胆总管一期缝合55例(鼻胆管组)与T管引流47例(T管组)的临床效果。
    结果:两组均成功完成手术,术后无胆瘘发生,鼻胆管组拔管时间(5.3±1.8)d,术后住院时间(7.2±1.6)d,肛门排气时间(20.3±5.8)d,均较T管组的(29.6±6.3)d,(15.3±3.8)d,(28.6±7.3)d明显缩短,差异有统计学意义(P<0.01); 手术时间及术后并发症两组比较,差异无统计学意义(P>0.05)。
    结论:术前置鼻胆管、胆总管一期缝合术既能避免一期缝合后胆管压力增高引起的胆瘘,又能彻底消除T管引起的并发症,缩短了住院天数,值得推广。

    Abstract:

    Objective:To research the clinical value of preoperative insertion of nasobiliary tube for after laparoscopic〖JP〗 exploration of common bile duct (CBD) and replacement of Ttube drainage with primary suture of (BD).
    Methods:A retrospective analysis of clinical data of 102 cases of laparoscopic common bile duct exploration due to choledocholithiasis. The clinical effects of 55 cases of preoperative insertion of nasobiliary tube and primary suture of common bile duct(Nasobiliary group) were compared with 47 cases of Ttube drainage(Ttube group).
    Results:Both of the groups successfully completed operation without postoperative bile leakage. The extubation time of nasobiliary group was (5.3±1.8)d. The postoperative hospitalization (7.2±1.6)d, time to pass flatus(20.3±5.8)d, which were all shorter than those of Ttube group (29.6±6.3d, and 15.3±3.8, respectively), with significant differences. There were no significant differences in operation time and complications (P>0.05) betweent the 2 groups (P<0.01).
    Conclusions:Preoperative insertion of nasobiliary tube and primary suture of common bile duct can prevent not only bile leakage caused by increased biliary pressure after primary suture, but also completely eliminates complications caused by Ttube,and can shortens hospital stay. It is worth widespresd application.

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王永恒, 张文兴, 刘欢, 吴洋鹏.术前置鼻胆管在腹腔镜胆总管探查一期缝合的应用研究[J].中国普通外科杂志,2009,18(2):2-.
DOI:10.7659/j. issn.1005-6947.2009.02.002

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  • 在线发布日期: 2009-02-25