腹腔镜下经腹顺行牵引法内镜气囊鼻胆管引流术231例

摘要

Objective To explore the clinical applied experience of the laparoscopic endoscopic balloon na-sobiliary drainage (LENBD) with a transperitoneal direct traction method.Methods A retrospective analysis of the clinical material was made in 231 patients with gallbladder stones, common bile duct stones and obstruction or stenosis of the duodenal papilla who were treated with laparoscopic common bile duct exploration (LCBDE) combined with LENBD.Results The gallbladders were excised by laparoscope method in the 231 cases. The rate of removing gallstones with choledochoscope and indwell nasal bile duct was 80.9% (187/231). The rate of removing gallstones with choledochoscope and duodenoscope, and indwell nasal bile duct, was 11.3% (26/231). The rate of removing gallstones by choledochoscope, and endoscopic sphincterotomy and primary suture was 2.6% (6/231). The rate of T tube drainage because of gallstone residue was 2.2% (5/231). The rate of urethral catheter drainage because of stenosis of duodenal papilla was 0.4% (1/231). The rate of direct primary suture due to the failure of endoscopic insertion of bile duct was 0.9% (2/231). The rate of the failure of common bile duct explo-ration because of small diameter of common bile duct and the failure of choledochoscope and duodenoscope was 0.4% (1/231). The rate of open common bile duct exploration and ENBD because of the failure of laparoscope was 1.3% (3/231). There were 2 cases (0.9%) of residual stones, 6 cases (2.6%) of bile leakage, 3 cases (1.3%) of mild acute pancreatitis and 1 case (0.4%) of reoperation due to intraperitoneal bleeding which were found after endoscopic nasobiliary drainage. There were no bowel perforation, bile duct perforation, severe pancreatitis or death. The total rate of postoperative complication incidence was 5.2% (12/231).Conclusion It is found from preliminary results of limited cases in this study that, if patients were suitable, it was feasible, effective and safe that LCBDE combined with LENBD for the treatment of cholecystolithiasis, common bile duct stones and the obstruction or stenosis of duodenal papilla.%目的 探讨腹腔镜下经腹顺行牵引法内镜气囊鼻胆管引流术(laparoscopic endoscopic bal-loon nasobiliary drainage,LENBD)的临床应用体会.方法 回顾性分析我院2010年4月至2016年9月期间,符合入选标准的231例胆囊结石、胆总管结石合并十二指肠乳头部梗阻或狭窄患者在腹腔镜胆总管探查术中施行LENBD的临床资料.结果 腹腔镜下成功切除胆囊231例.胆管镜取石并留置鼻胆管80.9%(187/231),胆管镜联合十二指肠镜取石并留置鼻胆管11.3%(26/231),胆管镜取石联合十二指肠镜乳头切开并行直接一期缝合术2.6%(6/231),因胆总管残石并腹腔镜下留置T形管2.2%(5/231),因乳头狭窄未解除留置鼻胆管失败并腹腔镜下留置输尿管导管0.4%(1/231),因十二指肠镜插入胆道失败而直接行一期缝合术0.9%(2/231),因胆总管过细且胆道镜和十二指肠镜取石均失败而放弃胆总管探查取石术0.4%(1/231),因腹腔镜下取石失败而中转为开腹胆总管探查取石术并留置鼻胆管1.3%(3/231).鼻胆管引流术后发现残石2例(0.9%),胆汁漏6例(2.6%),轻症胰腺炎3例(1.3%),腹腔内出血再手术1例(0.4%).无肠穿孔、胆管穿孔、重症胰腺炎等并发症,无死亡病例.术后总并发症发生率为5.2%(12/231).结论 从本医院有限病例进行初步研究发现,只要病例选择合适,在腹腔镜胆总管探查术中联合LENBD治疗胆囊结石、胆总管结石合并十二指肠乳头部梗阻或狭窄是可行、有效和安全的.