鼻胆管代替 T管在腹腔镜胆总管切开一期缝合中的应用

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。

Application of Nasobiliary Duct Instead of T-tube in Laparoscopic Common Bile Duct Exploration and Primary Suture

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 .