胆总管结石术后经鼻胆引流管注射生理盐水在超声检查残留结石中的应用

Application of endoscopic nasobiliary drainage with normal saline injection in detecting common bile duct residual stones by ultrasonography

目的探讨胆总管结石术后经鼻胆引流管注射生理盐水在超声检查残留结石中的应用价值。方法对50例经内镜逆行胰胆管造影术(ERCP)、十二指肠镜下乳头括约肌切开术(EST)、内镜鼻胆管引流术(ENBD)诊治胆总管结石的术后患者行常规超声及超声联合鼻胆引流管注射生理盐水检査,对比注射生理盐水前后超声测量胆总管长度、宽度及残留结石的检出率。结果 50例患者注射生理盐水前后胆总管全程显示率分别为18.00%(9/50)、90.00%(45/50);注射生理盐水前后超声检查胆总管长度分别为(2.63±0.26)cm,(5.79±2.17)cm,宽度分别为(0.49±0.35)cm、(0.99±0.35)cm,差异均有统计学意义(t=11.03,10.81,P均<0.01)。注射生理盐水前疑似胆总管结石1例,注射生理盐水后另增5例疑似存在胆总管结石,其中5例行ERCP检査:ERCP检查4例证实为胆总管结石,1例未见明显结石;1例经手术证实为胆总管结石。结论经鼻胆管引流管注射生理盐水可提高胆总管显示率,进而提高对残留结石的检出率。

Objective To investigate the diagnostic value of endoscopic nasobiliary drainage（ENBD） combined with normal saline（NS） injection in ultrasonography in detecting residual stones after choledocholithiasis surgery.Methods Fifty patients who treated by endosopic retrograde cholangio-pancreatography（ERCP）,duodenoscopic sphincterotomy incision surgery（EST） and ENBD for bile duct stones received ultrasonography and ENBD with NS injection in ultrasonography.The length and width of common bile duct before and after NS injection were compared,and the detection rate of residual stones were also calculated.Results The full display rate of the common bile duct before and after NS injection were18.00%（9/50） and 90.00%（45/50）,respectively.Before and after injection of NS,the length of common bile duct were（2.63±0.26）cm,（5.79 ± 2.17）cm,the width were（0.49 ± 0.35）cm,（0.99 ± 0.35）cm.The differences of the length and width of common blie duct before and after NS injection were statistically significant（t= 11.03,10.81,both P〈0.01）.Before injection NS,1 case of common bile duct stones was suspected;after injection,the other 5 cases of common bile duct stones were suspetcted.In the 6 cases of suspected bile duct stones,4 cases were confirmed by ERCP,1 case was false positive and 1 case was confirmed by operation.Conclusion The ENBD with NS injection in ultrasonography can increase the display rate of common bile duct which can improve the detection rate of residual stones.