鼻胆管剪裁技术临床应用效果的比较研究  

Comparative Study on Clinical Effect of Cutting Technique of Nasobiliary Duct

作　　者：孙巧玲[1] 霍天依 张四维 张志芸 周玉洁[1] Sun Qiaoling;Huo Tianyi;Zhang Siwei(Department of General Surgery, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院普通外科,北京100191

出　　处：《中国微创外科杂志》2022年第2期137-141,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评价鼻胆管剪裁技术对内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)后留置鼻胆管的应用价值。方法回顾性分析2018年1月~2021年10月ERCP+十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)+鼻胆管引流术(endoscopic nasobiliary drainage,ENBD)资料。普外科病房患者79例为剪裁组,接受改良鼻胆管管理方案,将鼻胆管外露部分剪至70 cm;消化科病房患者52例为对照组,接受医院常规鼻胆管管理方案。比较2组留置鼻胆管时间、非计划性拔管风险评分以及非计划性拔管、管路不畅、术后胆管炎和胰腺炎发生率。结果剪裁组鼻胆管留置时间较对照组长[中位数3.0(1~14)d vs.2.0(1~12)d,Z=-2.779,P=0.005],非计划性拔管风险评分高[(4.63±1.35)分vs.(3.88±1.13)分,t=3.303,P=0.001],但2组非计划性拔管率差异无显著性[0%(0/79)vs.3.8%(2/52),P=0.156],2组管路不畅、术后胆管炎和胰腺炎发生率差异均无显著性(P>0.05)。结论鼻胆管剪裁技术有利于降低非计划性拔管风险,规范和方便护士对鼻胆管的观察及记录,未增加术后胆管炎、胰腺炎并发症的发生率。Objective To evaluate the application value of the cutting technique of nasobiliary duct in indwelling nasal bile duct after endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of ERCP+endoscopic sphincterotomy(EST)+endoscopic nasobiliary drainage(ENBD)from January 2018 to October 2021 were analyzed retrospectively.There were 79 patients in the General Surgery Ward included in the cutting group.They received the improved management scheme of nasobiliary duct,and the exposed part of nasobiliary duct was cut to 70 cm.There were 52 patients in the Digestive Ward served as the control group and they received our hospital’s routine nasobiliary management scheme.The time of indwelling nasobiliary duct,risk score of unplanned extubation,incidence of unplanned extubation,obstructed pipeline,postoperative cholangitis and pancreatitis were compared between the two groups.Results The retention time of nasobiliary duct in the cutting group was longer than that in the control group[3.0(1-14)d vs.2.0(1-12)d,Z=-2.779,P=0.005]and the risk score of unplanned extubation was higher[(4.63±1.35)points vs.(3.88±1.13)points,t=3.303,P=0.001],but there was no significant difference in the rate of unplanned extubation between the two groups[0%(0/79)vs.3.8%(2/52),P=0.156].There was no significant difference in the incidence of obstructed pipeline,postoperative cholangitis and pancreatitis(P>0.05).Conclusion The cutting technique of nasobiliary duct is helpful to reduce the risk of unplanned extubation,and standardize and facilitate nurses’observation and recording of nasobiliary duct,and does not increase the incidence of complications of postoperative cholangitis and pancreatitis.

关 键 词：内镜逆行胰胆管造影 鼻胆管 非计划性拔管 

分 类 号：R65[医药卫生—外科学]