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腹腔镜胆总管探查术后不进行内镜鼻胆管引流的一期胆管缝合术的安全性和有效性

The Safety and Efficacy of Primary Duct Closure without Endoscopic Nasobiliary Drainage after Laparoscopic Common Bile Duct Exploration.

作者信息

Yang Yan, Han Lin, Lin Da-Ning, Hu Zeng-Ji, Tu Wei, Chen Feng, Li Yong-Qiang

机构信息

Department of Hepatobiliary Pancreatic Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China.

出版信息

Gastrointest Tumors. 2020 Oct;7(4):117-124. doi: 10.1159/000508874. Epub 2020 Aug 12.

Abstract

BACKGROUND

Primary duct closure (PDC) after laparoscopic common bile duct exploration (LCBDE) has been widely applied for choledocholithiasis. However, there has been controversy over the placement of endoscopic nasobiliary drainage (ENBD) during operation. To date, few studies compare the clinical effect of PDC without and with ENBD. The aim of this study was to assess the safety and efficacy of PDC without ENBD for choledocholithiasis.

METHODS

From January 2016 to December 2018, a total of 164 patients meeting the inclusion criteria were enrolled and divided into group A (undergone LCBDE + PDC without ENBD, 81 cases) and group B (undergone LCBDE + PDC with ENBD, 83 cases) in this study. The intraoperative conditions and postoperative complications were compared between the 2 groups.

RESULTS

In group A, the time of operation, postoperative first flatus, extubation, antibiotics, and discharge were shorter than in group B ( = -17.775, = 0.000; = -7.649, = 0.000; = -5.807, = 0.000; = -9.247, = 0.000; = -9.322, = 0.000, respectively). Furthermore, intraoperative blood loss was less ( = -2.199, = 0.029) and hospital costs were lower ( = -6.685, = 0.000). However, there was no significant difference in postoperative complications between the 2 groups ( > 0.05).

CONCLUSIONS

In patients who meet the screening criteria, PDC without ENBD after LCBDE is safe and effective and worthy of clinical application.

摘要

背景

腹腔镜胆总管探查术(LCBDE)后一期胆管缝合(PDC)已广泛应用于胆总管结石病。然而,术中内镜鼻胆管引流(ENBD)的放置一直存在争议。迄今为止,很少有研究比较有无ENBD情况下PDC的临床效果。本研究的目的是评估无ENBD的PDC治疗胆总管结石病的安全性和有效性。

方法

2016年1月至2018年12月,共纳入164例符合纳入标准的患者,本研究将其分为A组(行LCBDE + 无ENBD的PDC,81例)和B组(行LCBDE + 有ENBD的PDC,83例)。比较两组的术中情况和术后并发症。

结果

A组的手术时间、术后首次排气、拔管、使用抗生素时间和出院时间均短于B组(分别为 = -17.775, = 0.000; = -7.649, = 0.000; = -5.807, = 0.000; = -9.247, = 0.000; = -9.322, = 0.000)。此外,术中出血量更少( = -2.199, = 0.029),住院费用更低( = -6.685, = 0.000)。然而,两组术后并发症无显著差异( > 0.05)。

结论

在符合筛选标准的患者中,LCBDE后无ENBD的PDC安全有效,值得临床应用。

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