胆总管探查一期缝合鼻胆管引流与T管引流治疗胆囊结石合并胆总管结石的临床研究
徐垚 安东均 冯金鸽 王羊 王金涛 杨林 韩立 赵宝国 张成
摘 要
目的：比较腹腔镜胆囊切除联合胆总管探查一期缝合鼻胆管引流（LC+LBEPS+ENBD）与T管引流（LC+LCTD）的临床疗效，探讨胆总管一期缝合联合鼻胆管引流的可行性。
方法：回顾性分析2018年10月～2019年10月西安交通大学附属咸阳市中心医院肝胆外科130例行腹腔镜下胆囊切除合并胆总管探查患者的临床资料。按手术方式分为一期缝合鼻胆管引流组（n=66）和T管引流组（n=64）比较2组患者一般资料、手术总时间、术中出血量、术后肛门排气时间、术后首次下床活动时间、术后补液量、术后拔管时间、术后并发症发生率、术后住院时间、住院总费用等数据。
结果：2组患者术前一般资料、术前合并症、肝功能、胆总管直径、胆总管结石个数、大小、2组患者手术总时间、术中出血量、术后并发症例数等，差异无统计学意义（P＞0.05）。术后排气时间、术后下床活动时间、术后补液量、术后拔管时间、术后住院时间、住院总费用等，差异有统计学意义（P＜0.05）。
结论：在严格掌握手术适应证前提下，LC+LEBPS鼻胆管引流是安全有效的；相较于T管引流具有加速患者康复、缩短住院时间、减少住院费用等优势，值得临床进一步推广。
关键词
胆总管结石；腹腔镜胆总管探查；一期缝合；鼻胆管引流；T管引流
Clinical research of LC+LBEPS+ENBD and LC+LCTD in the treatment of cholecystolithiasis with choledocholithiasis
XU Yao，AN Dongjun，Feng jinge et al.（Department of Hepatobiliary Surgery，The Central Hospital of Xianyang City Affiliated to Xi'an Jiaotong University，Xianyang 712000，China）
ABSTRACT
Objective:To compare the clinical efficacy of Laparoscopic cholecystectomy+Laparoscopic common bile duct exploration and primary suture+Endoscopic nasobiliary drainage（LC+LBEPS+ENBD）and Laparoscopic cholecystectomy+Laparoscopic cho-ledocholithotomy and T-tube drainage（LC+LCTD），and to explore the feasibility of LC+LBEPS+ENBD.
Methods:Clinical data of 130 patients in the department of hepatobiliary surgery from The Central Hospital of Xianyang City Affiliated to Xi'a n Jiaotong University from October 2018 to October 2019 were retrospectively analyzed.Who undergoing Laparoscopic choledocholithotomy and Laparoscopic common bile duct exploration.According to the operation method，patients were divided into primary suture unite endoscopic nasobiliary drainage group（n=66）and T-tube drainage group（n=64）.Patients'general information，total operation time，intraoperative blood loss，postoperative anal exhaust time，postoperative bed activity time，postoperative rehydration quantity for the first time，postoperative extubation time，postoperative complications，postoperative hospital stay，total hospitalization cost and other indicators were compared between the two groups.
Results:There was no significant difference in preoperative general information，preoperative complications，liver function，diameter of common bile duct，number of common bile duct stones，total operation time，intraoperative blood loss and number of postoperative complications between the two groups（P＞0.05）.There were statistically significant differences in postoperative exhaust time，postoperative out-of-bed activity time，postoperative fluid rehydration，postoperative extubation time，postoperative hospitalization time and total hospitalization cost（P＜0.05）.
Conclusion:LC+LEBPS+ENBD is safe and effective under the premise of strict control of surgical indications.Compared with T-tube drainage，it can accelerate the rehabilitation of patients，shorten the hospital stay，reduce the cost of hospitalization，which is worthy of further clinical promotion.
KEY WORDS
Choledocholithiasis；Laparoscopic common bile duct exploration；Primary duct closure；Endoscopic nasobiliary drainage；T-tube drainage
胆囊结石是肝胆外科一种常见病，发病率约7%～10%，其中约10%～15%胆囊结石患者合并胆总管结石［1］。随着胆道微创技术的飞速发展。目前胆囊结石合并胆总管结石术式多样化，腹腔镜胆囊切除、胆总管探查一期缝合（Laparoscopic cholecystectomy+Laparoscopic common bile duct exploration and primary suture，LC+LBEPS）是目前主流术式之一。胆总管探查术后放置T管（Laparoscopic choledocholithotomy and T-tube drainage，LCTD）是国内外经典术式，留置T管会引起相关并发症影响患者术后康复。随着微创技术及快速康复理念（Enhanced recovery after surgery，ERAS）等理念的发展，胆总管一期缝合开始应用于临床，但是否每例患者都适合一期缝合，目前争议较大［1］。本研究回顾性分析咸阳市中心医院肝胆外科2018年10月～2019年10月130例实施LC+LBEPS联合鼻胆管引流和LC+LCTD治疗胆囊结石合并胆总管结石患者的临床资料，探索胆总管探查取石一期缝合联合鼻胆管引流的临床应用价值，现报道如下。