三镜联合鼻胆管引流多入路治疗细径胆总管结石的临床疗效

Clinical effect of three endoscopies combined with nasobiliary drainage through multipath in the treatment of small-diameter common bile duct stones

摘要:

目的：探讨多路径（经胆囊管路径或胆总管切开路径）同期三镜（腹腔镜+胆道镜+十二指肠镜）联合鼻胆管引流并一期缝合治疗细径胆总管结石的临床疗效。方法：采用回顾性分析方法。收集2016年1月至2018年12月成都市第二人民医院肝胆外科收治并行三镜联合经胆囊管路径或胆总管切开路径探查取石术+经腹置入鼻胆管引流术+一期缝合术的98例细径胆总管结石（≤0.8 cm）患者的临床资料。结果：98例病例均成功手术且术后恢复良好。77例行三镜联合经胆囊管路径胆总管探查取石术+经腹置入鼻胆管引流术+一期缝合术，21例行三镜联合胆总管切开探查取石术+经腹置入鼻胆管引流术+一期缝合术。术中估计出血量为（25.0±6.5） mL，手术时间为（183.2±51.9） min。腹腔引流管术后第一天引流量为（46.5±52.4） mL；鼻胆管术后第一天引流量为（187.3±119.8） mL。除1例带管（腹腔引流管+鼻胆管）出院外，余97例腹腔引流管全部拔除时间为术后（6.5±2.0） d；鼻胆管拔除时间为（5.3±1.9） d。住院时间为（12.1±4.1） d。术后漏胆者2例（2.0%），其中1例并发轻症腹膜炎（50.0%）；并发轻症胰腺炎者18例（18.4%）；术后残石（泥沙样结石）1例（1.0%）；因鼻胆管引流不畅再次手术1例（1.0%）。无肠穿孔、术后出血等并发症，无中转开腹、围手术期死亡病例。结论：严格掌握手术适应证，在可靠的腔镜缝合技术支持下，多路径同期三镜联合鼻胆管引流并一期缝合术治疗细径胆总管结石安全可行，临床疗效满意。

Abstract:

Objective：To investigate the clinical effect of multipath（cystic duct or common bile duct） and three endoscopies（la－paroscopy + choledochoscopy + duodenoscopy） combined with nasobiliary drainage and primary suture in the treatment of small-di－ameter common bile duct stones. Methods：Retrospectively analyzed clinical data of 98 patients with small-diameter common bile duct stones（≤0.8 cm） who underwent three endoscopic transcyctic common bile duct exploration/common bile duct exploration + nasobiliary drainage through abdomen + primary suture from January 2016 to December 2018 in our department. Results：All 98 pa－tients underwent operations successfully and recovered well. Among them，77 patients underwent three endoscopic transcyctic common bile duct exploration + nasobiliary drainage through abdomen + primary suture of common bile duct，while another 21 patients under－went three endoscopic common bile duct exploration + nasobiliary drainage through abdomen + primary suture. The estimated intra－operative bleeding volume was （25.0±6.5） mL and the operation time was （183.2±51.9） min. On the first day after operation，the drainage volume through abdominal cavity drainage tube was （46.5±52.4） mL；the drainage volume of nasobiliary duct was （187.3±119.8） mL. Except one patient discharged with a tube（abdominal drainage tube and nasobiliary duct），the other 97 patients removed abdominal drainage tube on （6.5±2.0） d after operation，and removed the nasobiliary tube on （5.3±1.9） d after operation. Hospital－ization time was （12.1±4.1） d. Two patients（2.0%） had postoperative bile leakage，and one of them（50%） complicated with mild peritonitis；18 patients（18.4%） complicated with mild pancre－atitis；one patient（1.0%） had residual stones（muddy stones）；one patient（1.0%） was re-operated due to obstruction of naso－biliary drainage. No complications of intestinal perforation and bleeding after operation；no conversion to laparotomy or periop－erative death. Conclusion：With the total comprehension of op－eration indication and the support of reliable endoscopic suture，simultaneous three endoscopies through multipath combined with nasobiliary drainage and primary suture is safe and feasible for treating the small-diameter common bile duct stones，and the clinical effect is good.