鼻胆管引流在治疗复杂性胆石症中的应用

目的　 分析应用外科手术与内镜手段联合治疗复杂性胆总管结石方法的安全性、可靠性和应用前景。 方法　对 4年中应用经内镜鼻胆管引流术 (ENBD)配合完成的 34例开腹胆总管探查取石、1期缝合术 (内衬ENBD导管 )进行回顾性分析及随访。 结果　34例手术均成功 ,术后无胆管残石、胆瘘、胆管炎等并发症。术后平均住院 (7.4± 2 .1)d。半年后随诊2 9例 ,均无胆管狭窄及结石复发。 结论　ENBD配合实施的开腹胆总管探查、1期缝合术是一种安全、可靠的手术方式 ,摒弃了传统术后“T”型管引流 ,确保了胆道系统完整性并缩短了术后住院时间。该项技术的灵活应用为治疗复杂性胆总管结石开辟了新途径。

Clinical Application of Endoscopic Nasobiliary Drainage in Patients with Complex Choledocholith

To introduce a new application of endoscopic nasobiliary drainage(ENBD) undergoing primary suture of the incision after choledocholithotomy for the operative management of patients with large and multiple common bile duct (CBD) stones Methods:From January 1997 to December 2000,34 cases undergoing choledocholithotomy for complex choledocholith with primary suture on the incision of CBD were retrospectively analyzed.ENBD was done to replace Ttube drainage and intraoperative cholangioscopy performed to remove CBD stones.Results:All cases were operated successfully.The clearance rato of CBD stones was 100%.There was no postoperative complication.The mean postoperative stay was 7.4 days.No recurrent stones were observed at a follow-up of 6 months for 29 patients.Conclusion:A combined approach for complex choledocholith with primary suture on CBD incision through ENBC after choledocholithotomy is a good therapeutical alternative thus changing the orthodox management of CBD stones.The advantages of the combined procedures are safety,without operative diffculty,minimal invasion and rapid recovery.