经内镜鼻胆管引流术在腹腔镜胆管探查中的作用

目的：应用经内镜鼻胆管引流术(ENBD)作为腹腔镜胆管探查术(LCBDE)胆管引流方式，探讨其应用价值。方法：对拟行腹腔镜下胆管探查的患者术前进行ENBD，后经胆总管探查切口应用液电碎石、胆道镜取石，将肝内外胆管结石取净，保留鼻胆管于胆管内，将胆总管探查切口一期缝合，常规放置腹腔引流管。术后经鼻胆管造影，肝内外胆管无残余结石，无胆漏，择期拔除腹腔引流管及鼻胆管。结果：共43例患者术前行ENBD，平均6．1d后行LCBDE。36例(83.7％)患者成功进行LCBDE，胆管探查切口一期缝合。术后经鼻胆管造影，发现1例(2．6％)术中胆道镜漏诊--小结石，经内镜取石后痊愈；无胆管狭窄及胆漏等并发症发生。另有7例患者(18．6％)中转开腹手术，其中2例保留鼻胆管，胆管切口行一期缝合，术后顺利拔除鼻胆管。38例患者(88．4％)均成功应用：ENBD进行胆管引流，平均3．2d拔除腹腔引流管，6.7d拔除鼻胆管，无相关并发症发生。结论：ENBD作为LCBDE胆管引流，是安全有效的方式，且术后引流时间短，并发症少，可充分发挥出腹腔镜治疗胆管结石微创的优势。

The role of ENBD in laparoscopic exploration of common bile duct

Objective To investigate the role of endoscopic nasobiliary drainage ( ENBD) of bile duct instead of T tube drainage during laparoscopic common bile duct exploration (LCBDE). Methods All the patients accepted ENBD before LCBDE / laparoscopic cholecystectomy (LC) + LCBDE. During the operation the stones were extracted by choledochoscopy or crashed with electrohydraulic lithotripsy. After removing all of the biliary stones, the nasobiliary tube still remained in the common bile duct, then primary closure of the exploration wound on the duct wall was made, and with routine abdominal drainage. After operation , radiography of the nasobiliary tube was taken to investigate if there were any residual stones or leakage in the bile duct remained. Subsequently the drainage tube and nasobiliary tube were respectively removed as indicated. Results Totally 43 cases accepted ENBD preoperatively, after 6. 1 days LCBDE was performed, in 36 cases (83. 7% ) the operation was successfully using nasobiliary drainage and primary closure of the duct wound. Postoperative radiography of the duct system through the nasobiliary tube showed only in one case (2. 6% ) a small stone left which was then extracted under ERCP. There were no bile duct stricture and bile leakage, so the nasobiliary tube was removed smoothly. Seven cases ( 18. 6% ) were transferred to open abdominal exploration, 2 of them still kept the nasobiliary tube and the choledochal incisions were primary closed. Totally 38 patients (88.4% ) were successfully drained by ENBD. The abdominal drainage and nasobiliary tubes were removed in average of 3.2 and 6.7 days respectively without complications. Conclusion ENBD is an effective and safe procedure for bile duct drainage in LCBDE. It has the advantage of minimal trauma, short drainage period and rare complications. It suggested that this procedure should be a new satisfied way in treatment of bile duct stones.