气囊鼻胆管在十二指肠乳头狭窄中的应用研究

目的探讨气囊鼻胆管引流术在同期三镜(腹腔镜、胆管镜、十二指肠镜)在治疗胆总管结石合并十二指肠乳头狭窄的临床应用价值。方法回顾性分析成都市第二人民医院2017年1月至2019年1月收治的胆总管结石合并十二指肠乳头狭窄患者64例。根据操作方法不同,分为2组,气囊鼻胆管组:经腹顺行引导气囊鼻胆管引流术32例;乳头切开组:输尿管导管引导下内镜乳头切开术32例。对比分析两组临床治疗效果。结果(1)术中及术后情况:两组均顺利完成手术,所有患者均顺利出院,无死亡病例。两组术中出血,术后肝功能(丙氨酸转移酶、天冬氨酸转移酶、总胆红素、直接胆红素),及术后住院时间、住院费用无统计学差异(P>0.05)。手术时间气囊鼻胆管组长于乳头切开组[(106.5±16.7)h vs(95.1±17.9)h,t=2.627,P<0.05]。而术后胃肠道功能恢复时间M(范围)[64(39~105)h vs 76(45~140)h,Z=2.518,P<0.05]及腹腔引流管拔管时间M(范围)[5(3~8)d vs 6(4~14)d,Z=-3.427,P<0.05]气囊鼻胆管组短于乳头切开组,差异有统计学意义。(2)术后并发症情况:术后胆漏、电解质紊乱、胰腺炎、引流失败发生率等均无统计学差异(P>0.05)。结论胆总管结石合并十二指肠狭窄患者行气囊鼻胆管引流术具有加速胃肠功能恢复、更早拔除腹腔引流管等优势,是一种安全有效的手术方式。

Application of laparoscopic balloon nasobiliary drainage in duodenal papillary stenosis

Objective To evaluate the clinical value of laparoscopic balloon nasobiliary drainage (LBNBD) in treatment of common bile duct stone (CBDS) complicated with duodenal papillary stenosis under laparoscopy, choledochoscopy and duodenoscopy. Methods A total of 64 patients with CBDS and duodenal papillary stenosis treated in Chengdu Second People’s Hospital from Jan. 2017 to Jan. 2019 were analyzed retrospectively. Patients were divided into two groups: balloon nasobiliary drainage group (n=32) and papillotomy group (n=32). The clinical therapeutic effects between the two groups were compared and analyzed. Results (1) Intraoperative and postoperative conditions: both groups completed the operation successfully, all patients were discharged smoothly, and there was no death. There was no significant difference between the two groups in terms of intraoperative bleeding, postoperative liver function (alanine transferase, aspartate transferase, total bilirubin, direct bilirubin) hospitalization time or hospitalization cost (P>0.05), while the operation time in the balloon nasobiliary drainage group was longer than that in the papillotomy group, which was (106.5±16.7)h vs (95.1±17.9)h, respectively (t=2.627, P<0.05). The recovery time of gastrointestinal function and extubation time of abdominal drainage drainage in the balloon nasobiliary drainage group were significantly shorter than those in the papillotomy group M(range) [64(39~105)h vs 76(45~140)h, Z=2.518, P<0.05] and [5(3~8)d vs 6(4~14)d, Z=-3.427, P<0.05], respectively, and the difference was statistically significant. (2) Postoperative complications: there was no significant difference in postoperative complications such as bile leakage, electrolyte disturbance, pancreatitis, or drainage failure (P>0.05). Conclusion Balloon nasobiliary drainage in patients with CBDS complicated with duodenal papillary stenosis has the advantages of accelerating the recovery time of gastrointestinal function and early removal of abdominal drainage tube, which is a safe and effective operation choice.