经腹逆向引导法术中十二指肠镜下鼻胆管引流术312例  

Transabdominal reverse guided nasobiliary drainage by intraoperative duodenoscopy

作　　者：陈安平[1] 胡铤 李华林[1] 王佳牧[1] 索运生[1] 刘安[1] 易斌[1] 张胜龙[1] 刘进衡 

机构地区：[1]成都市第二人民医院肝胆胰外科,610017

出　　处：《中华普外科手术学杂志（电子版）》2015年第4期34-36,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2013年成都市卫生局重大科技攻关项目(20130024)~~

摘　　要：目的探讨经腹逆向引导法术中十二指肠镜下鼻胆管引流术(IENBD)的手术方法和适应证。方法腹腔镜下或开腹下完成胆囊切除术。粗径胆总管:胆总管切开探查并取净结石,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针刀在输尿管导管或斑马导丝指引下施行乳头切开术以治疗合并的胆总管末端狭窄,然后采用经腹逆向引导法留置鼻胆管引流。一期缝合胆总管切口。细径胆总管:经胆囊管与胆总管汇合部切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜施行乳头切开术和取石术,然后采用经腹逆向引导法留置鼻胆管引流。结果粗径胆总管:施行腹腔镜下IENBD 237例,215例鼻胆管引流获得成功(90.7%)。施行开腹下IENBD 19例,19例鼻胆管引流和一期缝合术均获得成功(100%)。细径胆总管:施行腹腔镜下IENBD 52例,46例鼻胆管引流获得成功(88.5%)。施行开腹下IENBD 4例,4例鼻胆管引流获得成功(100%)。结论只要选择合适的病例,经腹逆向引导法术中十二指肠镜下鼻胆管引流术在腹腔镜下或开腹下均是可行、有效和安全的。Objective To explore the operative skills and indications for transabdominal reverse guided nasobiliary drainage by intraoperative duodenoscopy （ IENBD ） . Methods Cholecystectomy was performed by laparoscopy or laparotomy .For the treatment of thickening choledochus , the common bile duct should be explored and cleaned by choledochoscopy at first .Then an ureteric catheter or zebra guidewire was inserted into the duodenum , and duodenoscopy was performed to remove papillary stenosis using an electro-knife or pin-knife along the ureteric catheter and zebra guidewire .IENBD was achieved and the common bile duct was closed .For the treatment of thining choledochus , an ureteric catheter or zebra guidewire was inserted through the remnant of the cystic duct and common bile duct into the duodenum , and bile duct stone was extracted by sphincterotomy under a duodenoscope and endoscopic nasobiliary drainage with transabdominal reverse guide technique was performed . Results For the treatment of thickening choledochus, IENBD in laparoscopy was successful in 215 （90.7%） of 237 patients.IENBD in laparotomy was successful in 19 patients （100%）.For the treatment of thining choledochus , IENBD in laparoscopy was successful in 46 （88.5%） of 52 patients.IENBD in open laparotomy was successful in 4 patients （100%）. Conclusion For selected patients , transabdominal reverse guide technique of endoscopic nasobiliary drainage is safe and effective both in laparoscopy and laparotomy .

关 键 词：胆结石 胆囊切除术 腹腔镜 括约肌切开术 内窥镜 

分 类 号：R657.4[医药卫生—外科学]