内镜治疗中鼻胆管引流的临床应用价值

目的：探讨鼻胆管引流（ENBD）在内镜治疗胆胰系疾病中的作用和价值。方法：821例需要内镜逆行性胰胆管造影（ERCP）检查的病人，经ERCP检查，根据检查结果表明：胆总管结石（CBDS）病人根据结石的大小，先行经内镜乳头括约肌切开术（EST）或经内镜乳头气囊扩张术（EPBD）取石，对怀疑结石未取净或较大结石采用网篮机械碎石（ML）后行ENBD。急性梗阻化脓性胆管炎（AOSC）和胆源性胰腺炎（BOAP）的病人，生命体征不稳定有严重并发症的行ENBD。胆管末端及壶腹周围肿瘤的病人行ENBD减黄，择期手术。结果：该组111例病人行ENBD，59例CBDS病人经2－4次取净结石，无严重并发症。24例AOSC和8例BOAP症状缓解后取石治愈，无死亡。结论：内镜检查或治疗后放置ENBD，具有操作简单、安全、有效、有利于对胆胰系疾病病人的重复检查和治疗，以及对肿瘤病人的术前减黄，具有一定的临床应用价值。

CLINICAL VALUES OF NOSE-BILE DRAINAGEIN ENDOSCOPIC THERAPY

Objective:To access the effect and value of endoscopic nose-bile drainage (ENBD) for bilipancreatic diseases in endoscopic therapy.Methods:821 patients were managed with endoscopic retrograde cholangiopancreatography (ERCP).According to examing results:1.Patients with common bile duct stones (CBDS) were given endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation (EPBD).ENBD was carried for those whose stones were not completedly get rid of or those whose lare stones were managed with mechanical lithotripsy (ML).2. Patients with acute obstructive suppurative cholangitis (AOSC) and bile-original acute pancreatitis (BOAP),who had severe complications and whose life signs were not stable,were given ENBD.3.Those with periampullary carcinoma were managed with ENBD to reduce jaudice for selective operation.Results:Of 821 cases 111 were given with ENBD.59 cases with CBDS had no temnant stones and had no severe complications after 2～4times endoscopyc therapy.Stones of 24 with AOSC and 8 with BOAP were completedly get rid of after symptoms alleviated and no one died.Of 20 cases with tumor,17 were given operation after jaudice index decreased,3 were given endostent drainage.Conclusions:ENBD,given after endoscopic examination and therapy,is a simple,safe,effective method.It can be managed repeatedly for cholepancreatic diseases,reduce jaudice for patient with tumor before operation.So it has some clinical application value.