摘要目的 比较胆总管一期缝合经胆囊管胆管引流与鼻胆管引流的临床疗效.方法 回顾性收集2014年5月至2017年6月江苏省丹阳市人民医院经腹腔镜治疗的106例胆囊结石合并胆总管结石患者的临床资料.根据不同胆管外引流方式将患者分为两组:(1)研究组:腹腔镜胆总管切开一期缝合经胆囊管胆管引流;(2)对照组:腹腔镜胆总管切开一期缝合鼻胆管引流.每组各53例患者.比较两组患者的手术时间、术后引流量、术后住院时间、术后并发症等情况.结果 两组患者均顺利完成手术.与鼻胆管引流相比,经胆囊管胆管引流手术时间[(133.9±14.7)min比(143.3±21.7)min]缩短(t=-2.617,P<0.05).两组术后住院时间[(8.2±1.7)d比(7.7±2.5)d]和每日引流量的差异均无统计学意义(P值均>0.05).经胆囊管胆管引流术后发生导管堵塞1例、导管滑脱2例,未出现胆瘘.鼻胆管引流术后发生导管堵塞3例,导管滑脱1例,自行拔管2例,导管堵塞后引发胆瘘1例,并出现胆汁性腹膜炎,转开腹手术T管引流.术后随访1～17个月,平均8个月,超声检查均未见胆管狭窄,肝功能均正常.结论 胆总管一期缝合经胆囊管胆管引流同鼻胆管引流一样可以达到胆道引流的目的,维护了胆道的生理功能,在一定条件下简易、微创.

abstractsObjective To compare the clinical efficacy of transcystic biliary drainage with nasobiliary drainage during primary closure following laparoscopic choledochotomy. Methods The clinical data of 106 patients with cholecystolithiasis and choledocholithiasis treated by laparoscopy at Department of General Surgery,Danyang People′s Hospital from May 2014 to June 2017 were analyzed prospectively. The patients were divided into 2 groups by means of random number method: the study group was treated with transcystic biliary drainage, and the control group adopted nasobiliary drainage. The operation time, postoperative drainage volume, postoperative hospital stay and postoperative complications were compared between the 2 groups. Results All patients in the two groups completed the operation successfully. Compared with nasobiliary drainage, the operation time of transcystic biliary drainage was shortened ((133. 9±14. 7) minutes vs. (143. 3±21. 7) minutes,t=-2. 617,P<0. 05). Postoperative hospital stay ( ( 8. 2 ± 1. 7 ) days vs. ( 7. 7 ± 2. 5 ) days ) , the difference between the two groups was not statistically significant( P>0. 05 ) . The quantity of bile drainage was no significant difference in the two groups of patients. There were 1 case of duct obstruction and 2 cases of catheter slippage during transcystic biliary drainage, without causing bile leakage. During nasobiliary drainage, there were 3 cases of catheter obstruction,1 case of catheter slippage,2 cases of self extubation,1 case of bile peritonitis caused by catheter blockage,transferred to laparotomy and T tube drainage. The patients were followed up for 1 month to 17 months,with an average of 8 months. B-ultrasound showed no bile duct stenosis and hepatic function was normal. Conclusions Transcystic biliary drainage could achieve the same biliary drainage as well as nasobiliary drainage during primary closure following laparoscopic choledochotomy. In addition, transcystic biliary drainage maintain the physiological function of bile duct, it is simple and minimally invasive under certain conditions.