同期三镜、鼻胆管引流术在左肝合并胆总管结石的应用研究

Application of simultaneous triscopy and endoscopic nasobiliary drainage in hepatolithiasis complicated with choledocholithiasis

摘要:

目的： 探讨鼻胆管引流术（endoscopic nasobiliary drainage，ENBD）在同期三镜（腹腔镜、胆管镜、十二指肠镜）下治疗左肝内胆管结石合并胆总管结石的临床应用价值。方法： 回顾性分析四川省成都市第二人民医院肝胆胰外科2014年1月至2018年7月收治的左肝内胆管结石合并胆总管结石其中伴或不伴有胆囊结石的患者，共49例。均行腹腔镜下规则性肝叶切除+胆道镜下胆总管探查取石，其中观察组22例，采用十二指肠镜下安置鼻胆管引流；对照组27例，采用T管引流，对比分析鼻胆管引流组与T管引流组的临床疗效。观察指标：围手术期及随访情况。采用电话方式随访。本文采用SPSS 20.0统计学软件进行数据分析。结果： 术后排气时间鼻胆管引流组早于T管引流组，分别为（57.4±13.4）h、（67.9±12.7）h，差异有统计学意义（t=-2.818，t=0.007，均P<0.05）。术后带管时间鼻胆管引流组为4~12 d，明显短于T管引流组的75~95 d，差异有统计学意义（Z=-6.022，Z=0.000，均P<0.05）。结论： 针对本院有限的病例研究，左肝内肝管结石合并胆总管结石患者行鼻胆管引流术在未明显提高并发症的前提下，具有加速胃肠功能恢复时间、带管时间短等优势，是一种安全有效的手术方式。

Abstract:

Objective: To explore the clinical application value of endoscopic nasobiliary drainage (ENBD) in the treatment of left hepatolithiasis complicated with choledocholithiasis under simultaneous triscopy (laparoscopy, choledochoscopy and duodenoscopy). Methods: A total of 49 patients with left hepatolithiasis complicated with choledocholithiasis with or without cholecystolithiasis treated in the Department of Hepatopancreatobiliary Surgery of The Second People’s Hospital of Chengdu from January 2014 to July 2018 were analyzed retrospectively. All patients underwent laparoscopic regular hepatic lobectomy and laparoscopic choledocholithotomy. Among them, 22 cases were treated with ENBD (observation group), and 27 cases were treated with T-tube drainage (control group). The clinical effects of these two ways were comparatively analyzed. The observation indicators were perioperative period and the follow-up situations. The follow-up was made by telephone. SPSS 20.0 statistical software was used for the data analysis. Results: The postoperative exhaust time in the observation group was earlier than that in the control group, which was (57.4±13.4) h and (67.9±12.7) h, respectively, with statistical significance (t=-2.818, t=0.007, all P<0.05). The postoperative tube-taking time of the observation group was (4-12) d, which was significantly shorter than that of the control group (75-95) d, with statistical significance (Z=6.022, Z=0.000, all P<0.05). Conclusion: In view of the limited case study in our hospital, ENBD carried out in patients with left intrahepatic hepatolithiasis complicated with choledocholithiasis has the advantages of accelerating the recovery time of gastrointestinal function and shortening the tube-taking time, indicating that it’s a safe and effective surgical method.