本文選題：腹腔鏡膽道探查術(shù) + 膽總管結(jié)石��； 參考：《中國(guó)內(nèi)鏡雜志》2016年05期

【摘要】：目的比較分析腹腔鏡膽總管探查取石術(shù)后鼻膽管引流與T管引流治療膽囊結(jié)石合并膽總管結(jié)石(CBDS)的臨床療效。探討腹腔鏡膽總管探查、一期縫合并經(jīng)腹置鼻膽管引流術(shù)的臨床經(jīng)驗(yàn)。方法回顧性分析成都市第二人民醫(yī)院肝膽胰外科2014年5月-2015年5月55例膽囊結(jié)石合并CBDS患者分別行腹腔鏡下膽囊切除術(shù)+膽總管探查+一期縫合術(shù)+經(jīng)腹置鼻膽管引流30例(鼻膽管組)及腹腔鏡下膽囊切除術(shù)+膽總管探查+T管引流25例(T管組)的臨床資料,對(duì)比分析兩組患者的臨床治療情況。結(jié)果兩組手術(shù)時(shí)間、術(shù)后住院時(shí)間、胃腸功能恢復(fù)時(shí)間和膽道引流管留置時(shí)間差異有統(tǒng)計(jì)學(xué)意義(P0.05),鼻膽管組更具優(yōu)勢(shì);術(shù)中出血量,術(shù)后第1天膽汁引流量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后第2和3天膽汁引流量差異有統(tǒng)計(jì)學(xué)意義(P0.05),T管組優(yōu)勢(shì)更明顯。T管組術(shù)后并發(fā)癥共11例(44.0%),鼻膽管組共10例(33.3%),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但術(shù)后水、電解質(zhì)紊亂致厭食、惡心等消化道癥狀幾乎均由T管引流造成,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論腹腔鏡膽總管探查取石術(shù)后鼻膽管引流擴(kuò)大了膽總管一期縫合的適應(yīng)證,避免了T管引流的一系列弊端,并未增加膽漏、結(jié)石殘留及膽道狹窄等并發(fā)癥發(fā)生率,體現(xiàn)了微創(chuàng)外科技術(shù)的優(yōu)越性,適應(yīng)證范圍內(nèi)治療膽囊結(jié)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.
【作者單位】： 遵義醫(yī)學(xué)院研究生院;四川省成都市第二人民醫(yī)院肝膽胰外科;
【基金】：2014年成都市衛(wèi)生局一般科研項(xiàng)目(No:2014085)
【分類(lèi)號(hào)】：R657.4

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