改良鼻胆管与普通鼻胆管引流在经胆囊入路治疗细径胆总管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2022.02.035

摘要/Abstract

摘要： 目的探讨使用内镜下改良的鼻胆管引流(ENBD)在经胆囊入路治疗细径胆总管结石(CBDS)患者的疗效。方法 2015年12月～2018年6月我科诊治的54例细径CBDS患者(对照组),采用腹腔镜胆囊切除术(LC)后,在腹腔镜下经胆囊管行胆总管探查术,再在十二指肠镜协助下经腹顺行安置常规鼻胆管引流;2018年7月～2020年12月我科诊治的54例细径CBDS患者(观察组),手术方法同前,只是使用改良的鼻胆管进行引流。常规检测血清C反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果观察组术后胆汁引流量和鼻胆管拔管时间分别为(281.6±52.5)mL和(5.9±1.3)d,显著多于或长于对照组【分别为(228.7±53.2)mL和(4.0±1.4)d,P＜0.05],而住院日为(6.1±1.1)d,显著短于对照组[(8.1±1.3)d,P＜0.05】;观察组术后并发症,如胰腺炎、胆漏和鼻胆管滑脱发生率为7.4%,显著低于对照组的25.9%(P＜0.05);在术后1周,观察组血清CRP、IL-6和TNF-α水平分别为(42.8±11.1)mg/L、(3.2±0.8)ng/L和(1.0±0.8)ng/L,显著低于对照组【分别为(73.7±17.4)mg/L、(4.9±1.2)ng/L和(1.8±0.9)ng/L,P＜0.05】。结论与使用普通鼻胆管引流比,在经胆囊入路治疗细径胆总管结石患者时,使用改良的鼻胆管引流可减少引流管滑脱风险,提高引流效果,缩短术后恢复时间。

关键词: 胆总管结石, 腹腔镜胆囊切除术, 胆总管探查术, 改良鼻胆管引流, 治疗

Abstract: Objective The aim of this study was to investigate the modified endoscopic nosal biliary drainage (ENBD) through gallbladder approach in the treatment of patients with small-diameter common bile duct stones (CBDS). Methods A retrospective analysis was conducted, including 54 patients with small-diameter CBDS encountered in the hospital between December 2015 and June 2018 (control group) and other 54 cases presented between July 2018 and December 2020 (observation group). All patients underwent laparoscopic cholecystectomy (LC), followed by common bile duct exploration and ENBD, and the difference was the common nasal biliary drainage (NBD) was applied in the control and the modified NBD in the observation. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected routinely. Results The postoperative drainage volume of bile and extubation time of nasobiliary ducts in the observation were (281.6±52.5)mL and (5.9±1.3)d, significantly greater or longer than [(228.7±53.2)mL and (4.0±1.4)d, respectively, P＜0.05], while the hospital stay was (6.1±1.1)d, significantly shorter than [(8.1±1.3)d, P＜0.05] in the control group; the incidences of post-operational complications, such as pancreatitis, bile leakage and slippage of nasobiliary ducts in the observation was 7.4%, significantly lower than 25.9%(P＜0.05) in the control; one week after operation, serum CRP, IL-6 and TNF-α levels in the observation were (42.8±11.1)mg/L, (3.2±0.8)ng/L and (1.0±0.8)ng/L, significantly lower than [(73.7±17.4)mg/L, (4.9±1.2)ng/L and (1.8±0.9)ng/L, respectively, P＜0.05] in the control group. Conclusion Compared with the ordinary NBD tube, the application of modified NBD tube could reduce the risk of slippage, improve the drainage of bile and shorten the postoperative recovery in patients with small-diameter CBDS.

Key words: Cholelithiasis, Laparoscopic cholecystectomy, Common bile duct exploration, Endoscopic nosal biliary drainage, Modified nasobiliary ducts, Therapy

田婉婷, 陈保银, 马竹芳, 徐菁, 马臻奇. 改良鼻胆管与普通鼻胆管引流在经胆囊入路治疗细径胆总管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2022, 25(2): 291-294.

Tian Wanting, Chen Baoyin, Ma Zhufang, et al. Modified endoscopic nosal biliary drainage through gallbladder approach in treatment of patients with small-diameter common bile duct stones[J]. Journal of Practical Hepatology, 2022, 25(2): 291-294.

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改良鼻胆管与普通鼻胆管引流在经胆囊入路治疗细径胆总管结石患者疗效研究^*

Modified endoscopic nosal biliary drainage through gallbladder approach in treatment of patients with small-diameter common bile duct stones

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