经腹腔镜置入鼻胆管治疗有胆道手术史的胆总管结石应用分析

目的探讨经腹腔镜置入鼻胆管行引流治疗有胆道手术史的胆总管结石患者再行胆总管一期缝合术的安全性及可行性。方法选取2013年1月至2016年4月间成都市第二人民医院肝胆胰外科收治的56例既往有胆道手术史的胆总管结石患者,分为两组:鼻胆管组28例,行腹腔镜置入鼻胆管引流,并给予腹腔镜胆总管一期缝合术;T管组28例,行常规腹腔镜下胆总管探查、T管引流,观察并记录两组患者手术时间、术后白细胞及总胆红素下降水平、胆瘘、肠瘘、急性胰腺炎等并发症,以及术后带管时间和住院时间。结果 56例均手术成功。与T管组比,鼻胆管组术后胆红素水平恢复迅速,术后带管时间及住院时间明显缩短(P0.05),术后白细胞水平较低(P0.05),但两组手术时间、术后并发症(胆瘘、肠瘘、肝脓肿)发生率比较无明显差异(P0.05)。所有患者均随访6个月以上,复查MRCP未见结石残留、复发及胆道狭窄。结论经腹腔镜手术置入鼻胆管对既往有胆道手术史的胆总管结石患者行术后引流及一期缝合,是可行的且安全的。

Laparoscopic placement of ENBD for treatment of choledocholithiasis with biliary tract surgery history

Objective To investigate the safety and feasibility of laparoscopic endoscopic nasobiliary drain-age (ENBD) for treatment of choledocholithiasis with biliary tract surgery history. Methods A total 56 choledo-cholithiasis patients with biliary tract surgery history were selected in Chengdu Second People's Hospital from Jan. 2013 to Apr. 2016. Patients were divided into two groups: ENBD group (n=28) and T tube group (n=28). The duration of operation, the levels of white blood cells and total bilirubin after operation, duration of indwelling of tube, and the time of hospitalization were observed and recorded. Complications such as bile leakage, bile fis-tula, intestinal fistula and acute pancreatitis were recorded. Results Fifty-six cases were completed successfully by laparoscope. The level of bilirubin was recovered rapidly postoperative in the ENBD group, and the ENBD group had much shorter hospitalization and extubation time than the T tube group (P<0.05). The postoperative leukocyte level in ENBD group was lower than that of T tube group. No significant differences were found in the operative time and incidence of complications (bile leakage, intestinal fistula and liver abscess) between the two groups (P>0.05). All cases were followed up for 6 months. MRCP showed no residual stones, recurrence or biliary stricture 6 months after operation. Conclusion For choledocholithiasis patient with history of biliary tract surgery, laparoscopic placement of ENBD is safe and feasible.