摘要
目的探讨十二指肠镜下鼻胆管引流在胆囊结石合并胆总管结石腹腔镜术中的应用效果。方法回顾性分析2019年7月至2020年12月汕头大学医学院第二附属医院普外内镜血管科收治的90例胆囊结石合并胆总管结石患者的临床资料,按照术中引流方式的不同将患者分为观察组和对照组各45例。两组患者均给予腹腔镜胆囊切除术、腹腔镜胆总管探查取石术治疗,对照组给予T管引流,观察组给予十二指肠镜下鼻胆管引流。比较两组患者的围术期情况、术前及术后6个月胆囊收缩功能和胆囊壁厚度的变化、术后并发症以及术后6个月的随访情况。结果观察组患者术后拔管时间、住院时间分别为(6.88±1.16)d、(8.04±1.42)d,明显短于对照组的(15.04±3.71)d、(17.36±2.24)d,住院费用为(2.58±0.35)万,明显少于对照组的(2.82±0.40)万,差异均有统计学意义(P<0.05);术后,观察组患者的胆囊收缩功能和胆囊壁厚分别为(64.28±4.50)%,(2.20±0.42)mm,对照组胆囊收缩功能和胆囊壁厚分别为(45.16±4.42)%和(2.64±0.50)mm,观察组患者的胆囊收缩功能高于对照组,胆囊壁厚度小于对照组,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为8.89%,明显低于对照组的24.44%,差异有统计学意义(P<0.05);术后6个月随访结果显示,观察组患者的饭后腹胀、腹泻、腹痛的总发生率为6.67%,明显低于对照组的22.22%,差异有统计学意义(P<0.05)。结论十二指肠镜下鼻胆管引流在胆囊结石合并胆总管结石患者腹腔镜手术中的应用效果明显,值得推广应用。
Objective To study the application of nasal bile duct drainage under duodenoscope in laparoscopic surgery for gallbladder and common bile duct stones.Methods The clinical data of 90 patients with cholecystolithiasis and choledocholithiasis who underwent laparoscopic surgery in Department of General Endoscopic Vascular Surgery,Second Affiliated Hospital of Medical College of Shantou University from July 2019 to December 2020 were retrospectively analyzed.The patients were divided into the observation group and control group according to different drainage methods,with 45 cases in each group.Both groups were treated with laparoscopic cholecystectomy and laparoscopic common bile duct exploration and lithotripsy.The control group was treated with T tube drainage,and the observation group was treated with nasal bile duct drainage under duodenoscope.The perioperative conditions,the changes in gallbladder systolic function and the thickness of the gallbladder wall before and 6 months after the operation,postoperative complications and the follow-up 6 months after the operation of the two groups of patients were compared.Results The postoperative extubation time and hospital stay in the observation group were(6.88±1.16)d and(8.04±1.42)d,which were significantly shorter than corresponding(15.04±3.71)d and(17.36±2.24)d of the control group,and the hospitalization expenses were(2.58±0.35)×10 thousand,which were significantly less than(2.82±0.40)×10 thousand of the control group(P<0.05);after operation,the gallbladder contraction function and gallbladder wall thickness of the observation group were(64.28±4.50)%and(2.20±0.42)mm versus(45.16±4.42)%and(2.64±0.50)mm of the control group(P<0.05);the incidence of complications in the observation group was 8.89%,which was significantly lower than 24.44%in the control group(P<0.05);the follow up results for six months after operation showed that the total incidence of abdominal distension,diarrhea,and abdominal pain after meals in the observation group was 6.67%,which was significantly lower than 22.22%in the control group(P<0.05).Conclusion The application effect of nasal bile duct drainage under duodenoscope in laparoscopic surgery of cholecystolithiasis combined with choledocholithiasis is obvious,which is worthy of promotion and application.
作者
赵芝鑫
郑少坤
陈晓东
陈耿臻
ZHAO Zhi-xin;ZHENG Shao-kun;CHEN Xiao-dong;CHEN Geng-zhen(Department of General Endoscopic Vascular Surgery,Second Affiliated Hospital of Medical College of Shantou University,Shantou 515041,Guangdong,CHINA)
出处
《海南医学》
CAS
2022年第3期335-338,共4页
Hainan Medical Journal
基金
广东省汕头市医疗卫生科技计划项目(编号:190606165268435)。
关键词
胆囊结石
胆总管结石
鼻胆管引流
腹腔镜手术
并发症
Gallbladder stones
Common bile duct stones
Nasal bile duct
Laparoscopic surgery
Complications
