胆道镜探查和鼻胆管引流治疗复杂肝包虫合并胆瘘临床研究  

The clinical research of intraoperative choledochoscope check and nasal bile duct drainage in treatment ofhepatic hydatid combined biliary fistula

作　　者：刁红亮[1] 乌尔班[1] 罗超英[1] 王金龙[1] 刘光英 徐丽萍 

机构地区：[1]新疆克拉玛依市中心医院普通外科,834000 [2]消化内科

出　　处：《中华肝胆外科杂志》2013年第4期278-281,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评价胆道镜和鼻胆管引流治疗复杂肝包虫病合并胆瘘的应用价值。方法回顾性总结分析复杂肝包虫合并胆瘘144例的临床资料。其中肝包虫内囊摘除＋术中胆道镜探查和鼻胆管引流术组68例（治疗组），传统的内囊摘除术组76例（对照组），比较两组术式平均住院天数、残腔引流置管时间及残腔胆漏、残腔感染等指标。结果两组比较，治疗组T管使用率、残腔感染、术后胆瘘发生率明显低于对照组；住院时间、带管出院率和平均带管天数明显小于对照组，差异均有统计学意义（P〈0．05）。结论复杂肝包虫手术中使用胆道镜检查和引导鼻胆管引流，可减少包虫内容物残留和胆瘘漏诊，能可靠地处理胆瘘，减轻胆道压力，部分胆漏患者可以一期缝合胆总管，术后胆瘘和残腔感染发生率低，技术难度低，值得推广。Objective To evaluate application value of choledochoscope and nasal bile duct drainage in the treatment of complicated liver echinococcosis combined biliary fistula. Methods The anthors retrospectively summarized and analyzed the clinical data of 144 patients with complicated liver echinococcosis combined biliary fistula. Treatment group （n= 68） underwent liver hydatid internal capsule remove ＋ intraoperative choledochoscopy and nose biliary drainage,control group （n= 76） un- derwent the traditional internal capsule remove. The average length of hospital stay, residual cavity drainage catheter time, residual cavity bile leakage and residual cavity infection index of two groups were measured. Results The rate of T tube utilization, residual cavity infection, the incidence of bili- ary fistula in treatment group were significantly lower than the control group （P〈0.05）. The length of hospital stay, the rate of discharge with drainage tube and the average length with tube were signifi- cantly less than control group （P〈0.05）. Conclusion Intraoperative choledochoscopy and nasal bile duct drainage treatment of complicated liver hydatid, can reduce liver hydatid content residual and bili- ary fistula, reliable to deal with biliary fistula, part of a primary suture common bile duct, biliary fis- tula and residual cavity infection rate is low, patients recover quickly, shorter time of hospital stays, is worth popularizing.

关 键 词：肝包虫病 胆瘘 胆道镜 鼻胆管引流 治疗 

分 类 号：R657[医药卫生—外科学]