关键词: 胆总管结石, 胆囊结石, 经腹腔顺行放置鼻胆管引流, 胆总管一期缝合, 治疗

Abstract: Objective To explore the application value of nasobiliary drainage combined with primary suture of common bile duct in the treatment of patients with choledocholithiasis. Methods 164 patients with cholecystolithiasis and cholelithiasis were recruited in our hospital between March 2014 and March 2017,and were randomly divided into observation group （n=82） and control group （n=82）. Laparoscopic cholecystectomy and bile duct exploration were performed in both groups. The patients in the observation group were treated with intraperitoneal anterograde nasobiliary drainage combined with primary suture of common bile duct,and the patients in the control group were treated with T tube drainage. The amount of blood loss during operation and the operation time were observed in both groups. The recovery of intestinal functions,bile drainage and the complications were compared between the two groups. Results The amount of intraoperative bleeding in the observation group was （36.1±10.2） mL,similar to [（32.2±13.2） mL,P>0.05] in the control;the operative time was （96.6±21.5） min,also similar to[（91.5±19.1） min,P>0.05] in the control;the recovery time of intestinal function was（1.4±0.5） days,significantly shorter than（2.3±0.5） d（P<0.05） in the control;the time of drainage tube placement was （5.5±1.6） days,significantly shorter than （90.8±2.3） d （P<0.05） in the control;the hospitalization stay was （7.4±1.4） days,significantly shorter than （9.5±2.4） days （P<0.05） in the control,while the hospitalization cost was（38822.2±4019.7） yuan,significantly higher than（26744.7±3277.7） yuan in the control group;at day one postoperation the bile drainage in observation group was（267.3±102.8） mL,not significantly different as compared to （266.5±112.6） mL in the control （P>0.05）;at day 2 the bile drainage was （221.3±128.2） mL,significantly lower than （313.3±117.6） mL in the control （P<0.05） and at day 3 the bile drainage was（191.9±138.5） mL,significantly lower than （270.8 ±121.8） mL in the control（P<0.05）;the incidences of complications,such as bile leakage,intestinal hemorrhage,nausea and vomiting,and pancreatitis,in the two groups were not significantly different（8.4% vs. 12.2%,x²=0.591,P>0.05）. Conclusion The application of intraperitoneal anterograde nasobiliary drainage combined with primary suture of common bile duct in the treatment of patients with choledocholithiasis and cholelithiasis is efficient,which might significantly shorten the hospital stay and tube drainage.

Key words: Cholelithiasis, Choledocholithiasis, Nasobiliary drainage, Primary suture of common bile duct, Therapy