顺行鼻胆管引流术在腹腔镜胆道探查胆总管一期缝合术中的应用
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唐才喜, Email: tcx0826@163.com

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湖南省科技计划资助项目(2016SK4006);湖南省医药卫生科研计划资助项目(C2016109)。


Application of antegrade nasobiliary drainage in laparoscopic biliary tract exploration with primary closure of common bile duct
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    摘要:

    背景与目的:选择合适的手术方式对胆囊结石、胆总管结石患者良性预后具有重要作用,以往在腹腔镜胆道探查术基础上,实施T管引流术增加患者痛苦程度,不利于术后恢复,顺行鼻胆管引流术因更具微创理念受到临床关注。故本研究探讨顺行鼻胆管应用在腹腔镜胆道探查胆总管一期缝合术中的可行性及安全性。
    方法:选取2017年1月—2018年6月本院收治60例胆囊结石合并胆总管结石接受腹腔镜胆道探查术患者,随机分为对照组及观察组,每组各30例。观察组患者给予顺行鼻胆管引流、胆总管一期缝合术;对照组则留置T管引流。比较两组患者手术与恢复情况、患者术后胆汁引流量、术后1周营养指标、术前、术后1年评价患者肝功能指标,以及随访1年期间并发症发生情况。
    结果:两组手术耗时、术后第1天胆汁引流量差异无统计学意义(均P>0.05),观察组引流管留置时间、肛门首次排气时间、恢复正常生活时间、术后住院时间及住院费用均少于对照组,术后第2、3天的胆汁引流量低于对照组(均P<0.05);观察组术后1周白蛋白、前白蛋白水平均高于对照组(均P<0.05);两组术前各项肝功能指标均无明显差异(均P>0.05),术后1年,各项肝功能指标均较术前明显改善(P<0.05),但组间均无明显差异(均P>0.05);随访1年期间,观察组的总并发症发生率明显低于对照组(3.33% vs. 26.67%,P<0.05)。
    结论:顺行鼻胆管引流术、腹腔镜胆道探查术、胆总管一期缝合术联合应用,可缩短胆囊结石合并胆总管结石患者住院时间,促进患者术后快速康复,在一定程度上可减少并发症的发生率,具有一定可行性及安全性。

    Abstract:

    Background and Aims: The selection of an appropriate operation method is of great importance for the benign prognosis of patients with cholecystolithiasis and choledocholithiasis. In the past, the implementation of T-tube drainage on the basis of laparoscopic biliary exploration increases the degree of pain in patients, which is not conducive to postoperative recovery. Antegrade nasobiliary drainage has attracted more attention because of its minimally invasive concept. Therefore, this study was conducted to investigate the feasibility and safety of application of antegrade nasal bile duct in laparoscopic biliary tract exploration with primary closure of the common bile duct. 
    Methods: Sixty patients with cholecystolithiasis and concomitant choledocholithiasis underwent laparoscopic biliary tract exploration from January 2017 to June 2018 were selected and randomly assigned to control group and observation group, with 30 cases in each group. Patients in observation group were given nasal biliary drainage and primary closure of the common bile duct, and those in control group underwent T-tube placement and bile drainage. The surgical variables, postoperative recovery conditions, the volume of postoperative bile drainage, the nutritional indicators at 1 week after operation, and the liver function parameters before and 1 year after operation as well as the incidence of complications during 1-year followed-up period between the two groups were compared. 
    Results: The operative time and the volume of bile drainage on the first day after operation showed no significant difference between the two groups (all P>0.05). The drainage tube retention time, the time to first anal gas passage, the time to return to normal life, length of postoperative hospital stay and hospitalization costs as well as the volume of bile drainage on postoperative day 2 and 3 were all significantly reduced in observation group compared with control group (all P<0.05). The serum levels of albumin and prealbumin in observation group were significantly higher than those in control group at 1 week after operation (both P<0.05). There were no significant differences in each liver function parameter between the two groups before operation (all P>0.05), which were all significantly improved in both groups one year after operation (all P<0.05), but all showed no significant differences between the two groups (all P>0.05). The incidence of complications was significantly lower in observation group than that in control group during the 1-year follow-up period (3.33% vs. 26.67%, P<0.05). 
    Conclusion: The combined use of antegrade nasobiliary drainage, laparoscopic biliary tract exploration, and primary closure of the common bile duct can shorten the hospitalization time and accelerate postoperative recovery of patients with gallstones and common bile duct stones, and also reduces the incidence of complications to a certain extent. So, it has certain feasibility and safety.

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万健, 贺明连, 金少纯, 付卫东, 唐才喜.顺行鼻胆管引流术在腹腔镜胆道探查胆总管一期缝合术中的应用[J].中国普通外科杂志,2021,30(2):133-139.
DOI:10.7659/j. issn.1005-6947.2021.02.002

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  • 收稿日期:2020-07-03
  • 最后修改日期:2020-07-03
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  • 在线发布日期: 2021-02-25