经内镜鼻胆管引流联合腹腔镜胆道探查一期缝合术治疗高龄危重急性胆管炎  

The clinical treatment experience of endoscopic nose biliary drainage combined with laparoscopic common bile duct explorationwithprimary suture in the management of elderly patients with acute severe cholangitis

作　　者：秦建伟 向泓宇 许树林 李月胜 缪佰纹 庞耀平 党政 QIN Jian-wei;XIANG Hong-yu;XU Shu-lin(The 940th Hospital of Joint Logistic Support Force of PLA Department of Hepatobiliary Surgery,Lanzhou 730000;Northwest Minzu University Medical College,Lanzhou 730000,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院肝胆外科,兰州730000 [2]西北民族大学医学部

出　　处：《肝胆外科杂志》2022年第5期369-372,共4页Journal of Hepatobiliary Surgery

基　　金：军委后勤保障部应用基础研究项目(20BJZ23)。

摘　　要：目的探讨经内镜鼻胆管引流(ENBD)联合腹腔镜胆道探查一期缝合术治疗高龄危重急性胆管炎的安全性及可行性。方法2014年01月至2020年12月中国人民解放军联勤保障部队第九四〇医院肝胆外科共67例高龄危重急性胆管炎患者接受ENBD联合腹腔镜胆道探查一期缝合治疗,回顾性分析上述患者的手术时间、平均住院日、手术并发症,以及术后随访情况等临床资料。结果所有患者均被治愈,无死亡病例;3例术后轻度胆瘘,保持鼻胆管及腹腔引流通畅,均在1周内痊愈,未作特殊治疗;2例术后胆总管结石残留,经内镜胰胆管造影术(ERCP)取出结石;除1例术中发现鼻胆管脱出胆管,其余患者鼻胆管均在位。患者平均手术时间(121.9±18.6min),平均住院时间(13.2±5.9天),术后平均住院时间(8.1±2.8天),腹腔引流管放置时间(3~7天),患者手术耐受性好且定期随访未见显著并发症。结论合理把握手术适应症,对高龄危重胆管炎患者行ENBD联合胆道探查一期缝合术是一种疗效满意的治疗手段。Objective To explore the safety and feasibility of endoscopic nose biliary drainage(ENBD)combined with laparoscopic common bile duct exploration with primary suture in the management of elderly patients with acute severe cholangitis.Methods From January,2014 to December,2020,67 elderly critically ill patients with acute cholangitis in the Department of Hepatobiliary Surgery,the 94Oth Hospital of Joint Logistic Support Force of PLA received treatment of ENBD combined with laparoscopic common bile duct exploration with primary suture.The operative time,average hospital stay,operative complications,and postoperative followup of the above patients were retrospectively analyzed.Results All patients were cured,and there was no death case;3 cases of mild biliary fistula after operation,maintained smooth nasobiliary duct and abdominal cavity drainage,all recovered within 1 week without special treatment;2 cases of common bile duct stones remained after operation,and the internal endoscopic retrograde cholangiopancreatography(ERCP)was used to remove the stones;except for 1 case where the nasobiliary duct was found to be prolapsed during the operation,the nasobiliary duct was still in place in the rest of the patients.Average operation time(121.9±18.6min),average hospital stay(13.2±5.9 days),average postoperative hospital stay(8.1±2.8 days),abdominal drainage tube placement time(3-7 days),and patients'surgical tolerance Good and regular follow-up showed no significant complications.Conclusion Reasonable grasp of surgical indications,ENBD combined with laparoscopic common bile duct exploration with primary suture for elderly patients with critical cholangitis is a therapeutic method with satisfactory curative effect.

关 键 词：急性胆管炎 高龄 经内镜鼻胆管引流 腹腔镜下胆道探查一期缝合 

分 类 号：R657.4[医药卫生—外科学]