同期两镜或三镜下留置鼻胆管引流246例  

Naso-biliary drainage by combined use of laparoscopy, choledochoscopy and / or duodenoscopy:Report of 246 cases

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5期45-47,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的总结运用同期两镜或三镜术中留置鼻胆管引流的治疗经验。方法从1992年10月至2014年8月,运用同期两镜或三镜术中留置鼻胆管引流的手术方式,即腹腔镜术中十二指肠镜下鼻胆管引流术(LENBD),对246例患者进行治疗。结果 LENBD 246例中,180例胆管引流获得成功(73.2%),17例仅获得胰管引流(6.9%)。鼻胆管插管失败16例(6.5%),其中中转为输尿管导管胆管引流9例,T管引流3例,放弃胆管引流4例。鼻胆管打折导致无任何液体流出11例(4.5%)。鼻胆管早期滑脱15例(6.1%),并导致术后梗阻性黄疸1例,再次置鼻胆管治愈。术后胆漏2例(0.8%),经腹腔引流管引流自愈。乳头切开术后发生轻症胰腺炎5例(2.0%)。胆管无残石。无其他严重并发症,无死亡。结论只要选择合适的病例,同期两镜或三镜术中留置鼻胆管引流是可行、有效和安全的。Objective To summarize the clinical experience with naso-biliary drainage by combined use of laparoscopy, choledochoscopy and/or duodenoscopy （LENBD）. Methods From October 1992 to August 2014, 246 patients underwent LENBD. Results Among the 246 patients, 180 （73.2%） underwent biliary drainage successfully , and 17 （ 6. 9% ） only received pancreatic duct drainage. Nasal bile duct intubation failed in 16 （6.5%） patients, of whom intraoperative conversion for ureteral catheter drainage was done in 9 patients, T tube drainage in 3, and giving up bile duct drainage in 4. Eleven （4.5%） patients had no liquid outflow caused by nasobiliary discount, 15 （6. 1% ） had early detachment of the nasal bile duct, and 1 had postoperative obstructive jaundice but cured by replacement of a nasobiliary tube. Bile leakage occurred in 2 （0. 8% ） patients and were cured by trans-peritoneal drainage. Five （2.0%） patients had slight pancreatitis after duodenoseopic papillotomy. No residual stones were found in the biliary ducts of the 246 patients. No residual calculus and other serious complications occurred in the patients and no death was seen postoperatively. Conclusion LENBD is safe and effective in elective patients.

关 键 词：胆总管疾病 腹腔镜检查 引流术 

分 类 号：R657.4[医药卫生—外科学]