经内镜下鼻胆管引流术34例临床报道

Clinical application of endoscopic nasobiliary drainage with 34 patients of biliary and pancreatic disease

目的探讨内镜下鼻胆管引流术(ENBD)在临床应用的价值。方法对该院内镜下鼻胆管引流术34例患者的资料加以总结分析。ENBD方法是结合ERCP显示病变部位,经造影插入斑马导丝至病变上方扩张的胆管部位,导丝达到满意位置后退出导管,留置导丝,沿导丝边插入引流管,将鼻胆管从口中引出,再经鼻腔将鼻导管引出,在X线下进一步调整鼻胆管在十二指肠及胃内位置,妥善固定后行持续负压引流,接上引流袋,每天记录胆汁引流量及性状,鼻胆管放置2～4周,2周左右行鼻胆管造影,如临床无症状,血尿淀粉酶已正常,经夹管后无反应,予拔管。如造影有残余结石或夹管后有症状者,再次行ERCP和EST术取石。结果该组34例均置管成功,未出现并发症。胆源性胰腺炎患者单行ENBD10例,11例行EST术后放置鼻胆引流管,取出蛔虫2例,结石8例。急性化脓性胆管炎7例,均在发病24～36h内行ENBD,其中4例单行ENBD,3例行EST术后放置鼻胆引流管,患者腹痛迅速减轻或消失,体温降至正常,白细胞明显下降,其中3例出现中毒性休克,在抗休克同时行ENBD,一经引流,症状逐渐减轻,血压在6～24h恢复正常,未出现肝肾功能不全,其有效率为100%。胰胆肿瘤2例,经ENBD术后,改善了患者一般状况及肝功能,提高了手术耐受力。结论ENBD能使感染胆汁直接引流出来,迅速解除胆道梗阻,缓解临床症状,鼻胆管能使乳头开口保持通畅,防止取石不净引起部分残余结石的嵌顿,并消除胆胰反流的发生,降低胰管压力,减少胰腺炎发生,在胆胰疾病治疗中疗效确切,值得推广应用。

【Objective】To evaluate the clinic value of endoscopic nasobiliary drainage（ENBD） in the diagnosis and treatment of biliary and pancreatic disease.【Methods】34 cases treated by ENBD were retrospectively analyzed from August 2002 to March 2007.【Results】All cases were operated on successfully.No postoperative complication such as bile leakage,Hemobilia,cholangitis,etc occurred.【Conclusions】ENBD has further image diagnostic value,injury is minimal,better biliary arainage decompression,safety of the selective operations is increased in the cases with biliary obstruction,therefore it is worth applying.