同期三镜+气囊鼻胆管引流在胆囊结石合并细径胆总管结石治疗中的应用

目的探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)+气囊鼻胆管引流(balloon nasobiliary drainage,BND)在胆囊结石合并细径胆总管结石治疗中的临床应用价值。方法回顾性分析成都市第二人民医院2010年4月至2016年9月期间,符合入选标准的198例胆囊结石合并细径胆总管结石(胆总管内径0.3~0.8 cm)的患者临床资料。结果 198例均成功行腹腔镜胆囊切除术。胆管镜取石并留置鼻胆管126例(63.7%),胆管镜联合气囊鼻胆管取石并留置鼻胆管37例(18.7%),胆管镜联合十二指肠镜取石并留置鼻胆管19例(9.6%),胆管镜联合十二指肠镜乳头切开并行一期缝合术5例(2.5%)。因胆总管残石腹腔镜下留置T管4例(2.0%),因乳头狭窄未解除留置鼻胆管失败并腹腔镜下留置输尿导管1例(0.5%),因十二指肠镜插入食道失败而直接行一期缝合术2例(1.0%),因胆总管过细且胆道镜和十二指肠镜取石均失败而放弃胆总管探查取石术1例(0.5%),因腹腔镜下取石失败而中转开腹胆总管探查取石术并留置鼻胆管3例(1.5%)。术后总并发症发生率为4.0%(8/198),其中鼻胆管引流术后发现残石1例(0.5%),胆汁漏5例(2.5%),轻症胰腺炎2例(1.0%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡病例。结论从本组有限病例初步研究发现,只要病例选择合适,同期三镜下采用BND术治疗胆囊结石合并细径胆总管结石是可行、有效和安全的。

Application of laparoscopy,choledochoscopy, duodenoscopy at the corresponding period com-bined with balloon nasobiliary drainage in treatment of cholecystolithiasis with small diameter common bile duct stone

Objective To explore the clinical effect of laparoscopy, choledochoscopy, duodenoscopy at the corresponding period, combined with balloon nasobiliary drainage (BND) in treatment of cholecystolithiasis with small diameter common bile duct stone. Methods The clinical data of 198 cases of cholecystolithiasis with small diameter common bile duct stone (the internal diameter was 0.3~0.8 cm) admitted in Chengdu Second People's Hospital between Apr. 2010 and Sep. 2016 were retrospectively analyzed. Results Laparoscopic chole-cystectomy was successfully performed in 198 cases. Choledochoscopy and indwelling nasal bile duct performed in 126 cases (63.7%), joint choledochoscopy and balloon nasalbiliary and indwelling nasal bile duct performed in 37 cases (18.7%), joint choledochoscopy and duodenoscopy and indwelling nasal bile duct performed in 19 cases (9.6%), joint choledochoscopy and duodenoscopic sphincterotomy and primary suture performed in 5 cases (2.5%). Indwelling T tube in 4 cases (2.0%) because of residual stones in common bile duct, indwelling ureteral catheter in 1 case (0.5%) because of the failure of inwinding nasal bile duct, direct primary suture performed in 2 cases (1.0%) because of the failure of duodenal mirror inserting into the esophagus, giving up the common bile duct exploration in 1 case (0.5%) because of the failure of choledochoscopy and duodenoscopy, and 3 cases (1.5%) converted to open common bile duct exploration and indwelling nasal bile duct because of the failure in laparoscopy. Total postoperative complication rate was 4.0% (8/198). Residual stone was found in 1 case (0.5%),bile leakage was found in 5 cases (2.5%), mild pancreatitis was found in 2 cases (1.0%). Conclusion From this preliminary study, we suggest that if patients with indicated cholecystolithiasis and thin choledochus stones, BND is a safe and effective treatment.