鼻胆管代T管在胆总管探查中的应用价值

【摘要】  目的 探讨鼻胆管代替T管在胆总管探查及胆管一期缝合中的价值。方法 比较两种手术方式内镜下鼻胆管引流(endoscopic nasobiliary drainage，ENBD)+胆总管探查(common bile duct exploration，CBDE)+胆管一期缝合（n=56）和常规CBDE+T管(n=42)的术前肝功能及术前、后相关并发症和住院时间。结果 56例ENBD后行CBDE+胆管一期缝合术前肝功能明显改善(P＜0.01)，与常规CBDE+T管术前肝功能相比，差异有统计学意义(P＜0.01)；ENBD+CBDE+胆管一期缝合术后并发症明显减少(P<0.05)，住院时间缩短(P<0.05)。结论 鼻胆管可代替T管引流并能行胆道切口一期吻合，而且可改善患者术前肝功能，缩短住院时间，减少并发症的发生。

【关键词】  内镜下鼻胆管引流术；T管引流；胆总管结石；胆总管探查；一期缝合

The applied value of nasobiliary duct instead of T-tube in common bile duct exploration     

　　ZHU Zhongchao， GONG Zhao， LI Bing， et al. Department of Ｈepatobiliary Ｓurgery， the First Ｈospital of Wuhan， Wuhan 430022
 
　　Abstract   Objective  To explore the applied value of nasobiliary duct instead of T-tube in one stage suture after common bile duct exploration (CBDE). Methods  Fifty-six cases of stone in common bile duct were chosen for one stage suture after endoscopic nasobiliary drainage (ENBD) and CBDE； and forty-two cases of stone in common bile duct were selected for routine CBDE and T-tube drainage. Liver function and complications and duration of hospital stay after operation in both groups were compared. Results  Liver function of patients was improved after ENBD (P＜0.01)， difference was significant compared to routine CBDE and T-tube drainage (P＜0.01). CBDE with ENBD instead of T-tube was obviously reduced postoperative complications and shortened duration of hospital stay for one stage suture. Conclusion  ENBD nasobiliary duct may substitute for T-tube in one stage suture after CBDE and improve hypohepatia and reduced postoperative complications.
 
　　Key words  endoscopic nasobiliary drainage； T-tube drainage；common bile duct stone； common bile duct exploration； one stage suture

　　胆总管探查(common bile duct exploration，CBDE)后胆道放置T管引流是传统经典的胆道手术方式，也是临床上胆总管结石最常采用的术式，但其有明显的缺点。内镜下鼻胆管引流术(endoscopic

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