中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
4期
314-316
,共3页
腹腔镜胆总管切开%内镜下鼻胆管引流术%T管引流%一期缝合
腹腔鏡膽總管切開%內鏡下鼻膽管引流術%T管引流%一期縫閤
복강경담총관절개%내경하비담관인류술%T관인류%일기봉합
Laparoscopic common bile duct exploration%Endoscopic nasobiliary drainage%T-tube drainage%Primary suture
目的：探讨鼻胆管代替T管在腹腔镜胆总管切开一期缝合中的应用价值。方法2010年3月～2013年3月将58例未并发急性胆管炎的胆总管结石，排除腹腔镜手术禁忌证后按住院号的尾数分组：奇数为对照组，行腹腔镜胆总管探查＋T 管引流；偶数为研究组，行内镜下鼻胆管引流术（ endoscopic nasobiliary drainage ， ENBD ）＋腹腔镜胆总管切开（ laparoscopic common bile duct exploration ，LCBDE）一期缝合，比较2组术中、术后情况。结果58例均成功实施手术。研究组术后住院时间明显短于对照组[（7．5±2．1）d vs．（10．3±3．2）d，t＝-3．965，P＝0．000]，2组胆漏发生率、手术时间及术后切口疼痛比较无明显差异（P＞0．05）。所有患者随访6～12个月，平均9个月，无一例因本次胆道手术发生远期并发症而再次入院，术后6个月复查MRCP再次证实无胆道狭窄、残留结石等并发症。结论鼻胆管在胆总管探查术中可代替T管引流，能保障腹腔镜胆总管切开一期吻合的安全性，减少T管相关并发症的发生，缩短住院时间。
目的：探討鼻膽管代替T管在腹腔鏡膽總管切開一期縫閤中的應用價值。方法2010年3月～2013年3月將58例未併髮急性膽管炎的膽總管結石，排除腹腔鏡手術禁忌證後按住院號的尾數分組：奇數為對照組，行腹腔鏡膽總管探查＋T 管引流；偶數為研究組，行內鏡下鼻膽管引流術（ endoscopic nasobiliary drainage ， ENBD ）＋腹腔鏡膽總管切開（ laparoscopic common bile duct exploration ，LCBDE）一期縫閤，比較2組術中、術後情況。結果58例均成功實施手術。研究組術後住院時間明顯短于對照組[（7．5±2．1）d vs．（10．3±3．2）d，t＝-3．965，P＝0．000]，2組膽漏髮生率、手術時間及術後切口疼痛比較無明顯差異（P＞0．05）。所有患者隨訪6～12箇月，平均9箇月，無一例因本次膽道手術髮生遠期併髮癥而再次入院，術後6箇月複查MRCP再次證實無膽道狹窄、殘留結石等併髮癥。結論鼻膽管在膽總管探查術中可代替T管引流，能保障腹腔鏡膽總管切開一期吻閤的安全性，減少T管相關併髮癥的髮生，縮短住院時間。
목적：탐토비담관대체T관재복강경담총관절개일기봉합중적응용개치。방법2010년3월～2013년3월장58례미병발급성담관염적담총관결석，배제복강경수술금기증후안주원호적미수분조：기수위대조조，행복강경담총관탐사＋T 관인류；우수위연구조，행내경하비담관인류술（ endoscopic nasobiliary drainage ， ENBD ）＋복강경담총관절개（ laparoscopic common bile duct exploration ，LCBDE）일기봉합，비교2조술중、술후정황。결과58례균성공실시수술。연구조술후주원시간명현단우대조조[（7．5±2．1）d vs．（10．3±3．2）d，t＝-3．965，P＝0．000]，2조담루발생솔、수술시간급술후절구동통비교무명현차이（P＞0．05）。소유환자수방6～12개월，평균9개월，무일례인본차담도수술발생원기병발증이재차입원，술후6개월복사MRCP재차증실무담도협착、잔류결석등병발증。결론비담관재담총관탐사술중가대체T관인류，능보장복강경담총관절개일기문합적안전성，감소T관상관병발증적발생，축단주원시간。
Objective To explore the application value of nasobiliary duct instead of T-tube in primary suture after laparoscopic common bile duct exploration (LCBDE). Methods A total of 58 cases of choledocholithiasis without acutecholangitis were divided into experimental and control group according to the odevity of the last number of admission number .Patients in odd number belonged to experimental group , while the even number patients belonged to control group .The experimental group received endoscopic nasobiliary drainage ( ENBD ) combined with LCBDE and primary suture;the control group underwent LCBDE combined with T-tube drainage .The intraoperative and postoperative data were compared between the two groups . Results All surgeries were completed successfully under laparoscope .The experimental group had much shorter hospital stay than that of the control group [(7.5 ±2.1) d vs.(10.3 ±3.2) d,t=-3.965,P=0.000].No significant differences were found in the operative time , incidence of bile leakage and postoperative incision pain between the two groups (P>0.05).All the cases were followed up for 6-12 months (average, 9 months) and no patients were hospitalized due to complications related to the billiary surgery .MRCP showed no complications such as biliary stricture and residual stones 6 months after operation . Conclusions Nasobiliary duct can substitute for T-tube in LCBDE .It ensures the safety of the primary suture and reduces T-tube related complications .
