术中内镜乳头括约肌切开和鼻胆管引流术219例  

Endoscopic papillotomy and nasobiliary drainage during the course of common bile duct exploration： a report of 219 cases

作　　者：陈安平[1] 周华波[1] 高原[1] 李华林[1] 索运生[1] 易斌[1] 刘安[1] 刘进衡 张胜龙[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,610017

出　　处：《中华肝胆外科杂志》2017年第3期200-202,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：回顾性总结成都市第二人民医院完成的219例术中内镜乳头括约肌切开术（IEST）和鼻胆管引流术（IENBD）治疗胆结石、胆总管结石合并乳头狭窄及行一期缝合术患者的临床资料。手术方式包括腹腔镜下完成胆囊切除、胆总管探查取石、IEST和IENBD198例，开腹完成21例。腹腔镜下IENBD成功治疗186例，鼻胆管打折或堵塞导致无任何液体流出7例，鼻胆管早期滑脱5例。腹腔镜术后发生胆汁漏4例，轻症胰腺炎3例，误扎鼻胆管头部1例。21例开腹手术均获得成功，无并发症。两组患者均无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症，无围手术期再手术或死亡。结果显示，只要患者选择合适，术中行IEST和IENBD治疗胆结石、胆总管结石合并乳头狭窄及一期缝合术，在腹腔镜下或开腹下均是安全有效的。To explore the operation methods and indications of the duodenoscopic papillotomy （IEST） with endoscopic nasobiliary drainage （IENBD） for the treatment of duodenal papilla stenosis during the course of common bile duct operation.The clinical data of 219 cases of cholecystolithiasis with choledocholith and the stenosis of papillary underwent endoscopic sphincterotomy （IEST） plus endoscopic nasobiliary drainage （IENBD） in the Second People＇s Hospital of Chengdu were retrospectively analyzed.It was successful in 198 cases who had the gallbladder and common bile duct stones removed,and endoscopic papillary dissection was performed and the nasobiliary tube was successfully inserted.Nasobiliary drainage was successful in 186 cases （93.9%） of 198 cases.No liquid outflow was observed in nasobiliary drainage in 7 cases （3.5%）.Nasal bile duct slipped early in 5 case （2.5%）.Primary closure of bile duct incision was completed in 198 cases.It failed in 4 cases （2.0%） who had the bile leakage with primary closure of duct incision.Mild pancreatitis after operation occurred in 3 cases （1.5%）.Nose bile duct ligation was performed in 1 case （0.5%）.The overall postoperative complication rate was 4.0% （8/198）.IEST ＋ IENBD in open laparotomy was successful in 21 cases.No perforation of intestine and bile duct,bleeding,severe pancreatitis and other complications and death were detected postoperatively in two groups.During the course of laparoscopy and open laparotomy,IEST ＋ IENBD in treating cholecystolithiasis with choledocholith and the stenosis of papillary and primary closure of duct incision after the endoscopic nasobiliary drainage is safe and effective.

关 键 词：腹腔镜 十二指肠镜 内镜乳头括约肌切开术 鼻胆管引流术 胆石症 

分 类 号：R657.42[医药卫生—外科学]