摘要
目的探讨腹腔镜下经腹置入鼻胆管引流的优缺点及其临床应用价值。方法采用腹腔镜、胆道镜和十二指肠镜联合鼻胆管引流治疗胆囊结石合并胆总管结石患者共204例。其中经口置入鼻胆管组42例，经腹置入鼻胆管组162例。分析比较两组引流成功率和并发症发生率。结果经腹置入鼻胆管的162例患者中，置管失败4例（2．5％），鼻胆管无任何液体流出6例（3．7％）；鼻胆管引出肠液3例（1．8％）；术后发生胆漏3例（1．8％）；术后发生胰腺炎2例（1．2％）；误扎鼻胆管尾端1例（0．6％）。在经口组置管失败6例（14．3％），鼻胆管无任何液体流出1例（2．4％）；鼻胆管引出肠液1例（2．4％）；术后发生胆漏1例（2．4％）；术后发生胰腺炎4例（9．5％）。经腹组安置鼻胆管的成功率明显高于经口组，且并发症低于经口组。结论腹腔镜下经腹置入鼻胆管引流在治疗胆囊结石合并胆总管结石方面有较高的临床应用价值，具有易操作、成功率高且并发症少的优点。
Objective To compare using the transabdominal route versus the transoral route in establishing naso-biliary drainage in laparoscopic surgery. Methods The combined use of laparoscopy with choledochoscopy and duodenoscopy to establish naso-biliary drainage was carried out in 204 patients with gallbladder and common bile duct calculi. In 162 patients, the naso-biliary drainage was established transabdominally and in 42 patients it was established transorally. The success and the complication rates in the two groups were compared. Results Of 162 patients using the transabdominal route, 4 patients failed. There were 6 patients （3.7%） who had no output from the nasobiliary drain. There were 3 patients （ 1.8% ） who had only intestinal juice outflow from the nasobiliary drain. Primary closure failed in 3 patients （ 1.8% ）, all resulting in bile leak. Pancreatitis occurred in 2 patients （ 1.2% ） after the operation. There was 1 patient （0.6%） whose nasobiliary drain was wrongly ligated. Of 42 patients with nasobiliary drainage using the transoral route, 6 patients failed. There was 1 patient （ 2.4% ） who had no output from the nasobiliary drain. There was 1 patient （2.4%） who had intestinal juice output from the nasobiliary drain. Primary clo- sure failed in 1 patient （2.4%） with resultant bile leakage. Pancreatitis occurred in 4 patients （9.5%） after the operation. The success rate of establishing a nasobiliary drainage in the transabdominal group was significantly higher than that in the transoral group, but the complications were less. Conclusions Nasobiliary drainage established through the transabdominal route in laparoscopy surgery for patients with gallbladder and common bile duct calculi was technically easier and had a high success rate. It had less complications.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2016年第8期534-536,共3页
Chinese Journal of Hepatobiliary Surgery
关键词
腹腔镜
胆道镜
胆总管结石
鼻胆管
Laparoscope
Choledochoscope
Choledocholithiasis
Nose bile duct
