内镜鼻胆囊引流治疗胆总管结石合并急性化脓性胆囊炎  

Effect of endoscopic nasal gallbladder drainage for the treatment of common bile duct stones combined with acute suppurative cholecystitis

作　　者：杜子强 张桂信[1] 张诚 DU Ziqiang;ZHANG Guixin;ZHANG Cheng(Department of General Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning 116021,China;Center of Gallstone Disease,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]大连医科大学附属第一医院普外科,辽宁大连116001 [2]同济大学附属东方医院胆石病中心/同济大学医学院胆石病研究所,上海200120

出　　处：《肝胆胰外科杂志》2024年第8期481-485,490,共6页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 评估内镜鼻胆囊引流(ENGD)治疗胆总管结石合并急性化脓性胆囊炎的安全性和有效性。方法 回顾性纳入2023年1—12月大连医科大学附属第一医院及同济大学附属东方医院收治的46例胆总管结石合并急性化脓性胆囊炎患者,其中21例行内镜逆行胰胆管造影(ERCP)取石+ENGD治疗(ENGD组),另外25例行ERCP取石+经皮肝穿刺胆管引流(PTGD)(PTGD组),比较两组操作成功率、手术时间、并发症发生率、不良事件发生率、住院时间、治疗费用、患者满意度,以及二期腹腔镜胆囊切除(LC)手术时间、并发症发生率、腹腔引流管留置率及住院时间。结果 两组患者操作成功率均为100%。ENGD组和PTGD组在手术时间[(46.4±4.8)min vs (55.0±6.0)min]、治疗费用[(3.2±0.3)万元vs (3.5±0.3)万元]、患者满意度[5(5,5)分vs 4(4,5)分]方面的比较,差异具有统计学意义(P<0.05);ENGD组二期LC手术时间[(45.4±7.0)min vs (58.4±9.2)min]、并发症发生率[1(4.8%) vs 7(28.0%)]、腹腔引流管留置率[10(47.6%) vs 23(92.0%)]及住院时间[(3.6±0.7)d vs (4.7±0.6)d]均低于PTGD组,差异具有统计学意义(P<0.05)。结论 ENGD治疗胆总管结石合并急性化脓性胆囊炎安全、有效,患者满意度高,并能降低LC风险。objective To evaluate the safety and efficacy of endoscopic nasal gallbladder drainage(ENGD)in the treatment of common bile duct stones combined with acute suppurative cholecystitis.Methods The clinical data of 46 patients with common bile duct stones and acute suppurative cholecystitis,who admitted in the First Affiliated Hospital of Dalian Medical University and Shanghai East Hospital between Jan.2023 and Dec.2023,was retrospectiveley analyzed.Among the 46 patients,21 patients received endoscopic retrograde cholangiopancreatography(ERCP)+ENGD treatment(the ENGD group),25 patients received ERCP+percutaneous transhepatic cholangial drainage(PTGD)treatment(the PTGD group).The operation success rate,operation time,incidence rate of postoperative complications,incidence of adverse events,hospitalization time,operation costs,patient satisfaction,and the indexes between secondary laparoscopic cholecystectomy(LC)including operation time,incidence rate of postoperative complications,rate of abdominal drainage tubes retention,and hospitalization time between the two groups were compared.Results The operation success rate in both groups were 100%.The ENGD group had 4 shorter opration time[(46.4±4.8)min vs(55.0±6.0)min],lower operation costs[(3.2±0.3)×10 yuan vs 4(3.5±0.3)×10 yuan]and higher patient satisfaction[5(5,5)vs 4(4,5)],the differences were all significant(P<0.05).For secondary LC,the operation time[(45.4±7.0)min vs(58.4±9.2)min],incidence rate of postoperative complications[1(4.8%)vs 7(28.0%)],rate of abdominal drainage tube retention[10(47.6%)vs 23(92.0%)],and hospitalization time[(3.6±0.7)d vs(4.7±0.6)d]in the ENGD group were all significantly lower than those in the PTGD group(P<0.05).Conclusion For treatment of common bile duct stones combined with acute suppurative cholecystitis,ENGD is safe and effective,with high patients’satisfaction and low LC risk.

关 键 词：内镜逆行胰胆管造影 急性化脓性胆囊炎 胆总管结石 内镜鼻胆囊引流 经皮肝穿刺胆管引流 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]