鼻胆管口鼻转换及固定新方法的设计与临床应用

Design and clinical application of a new method for oronasal conversion and fixation of nasobiliary duct

为评价一套鼻胆管口鼻转换及固定的新方法——短鼻胆管导丝引出及单反α固定法的临床应用价值,选择2022年1—8月在同济大学附属东方医院拟行经内镜鼻胆管引流术的患者为研究对象,按照随机数字表法随机分为短鼻胆管导丝引出及单反α固定法组(观察组,n=145)和导丝套取及反a固定法组(对照组,n=71),观察两组操作时间、一次操作成功率、不良事件、舒适度、满意度等指标差异。结果显示观察组操作时间低于对照组,差异具有统计学意义[102(91,117)s比136(127,145)s,Z=-9.639,P<0.001];观察组鼻胆管口鼻转中一次操作成功率高于对照组[88.28%(128/145)比67.61%(48/71),χ^(2)=13.496],鼻咽部刺激评分[1(1,2)分比2(1,2)分,Z=-4.457]和不良事件发生率[4.14%(6/145)比15.49%(11/71),χ^(2)=8.475]低于对照组,差异均有统计学意义(P<0.05);观察组留置鼻胆管期间胆汁引流量[(179.45±81.54)mL比(142.89±55.69)mL,t=3.407]及护理满意度评分[(7.72±0.99)分比(6.06±1.07)分,t=11.337]高于对照组,舒适度评分[(3.00±1.01)分比(4.83±0.99)分,t=-12.642]及不良事件发生率[3.45%(5/145)比14.08%(10/71),χ^(2)=8.344]低于对照组,差异均有统计学意义(P<0.05);观察组拔除鼻胆管的操作时间低于对照组,差异有统计学意义[(9.00±1.14)s比(11.93±1.36)s,t=-16.616,P<0.001]。由此可见,内镜下鼻胆管引流术后采取短鼻胆管导丝引出及单反α固定法进行鼻胆管口鼻转换及固定具有操作简单、刺激反应小、不良事件发生率低等优点,值得临床推广。

To evaluate the clinical value of a new method of guide wire extraction and single reverse-αfixation with short nasobiliary duct for oronasal conversion and fixation,patients who underwent endoscopic nasobiliary drainage in Shanghai East Hospital,Tongji University from January to August 2022 were selected.They were randomly divided into guide wire extraction and single reverse-αfixation with short nasobiliary duct group(the observation group,n=145)and guide wire taking and reverse-αfixation group(the control group,n=71).The operation time,one-time operation success rate,adverse events,comfort and satisfaction between the two groups were compared.The operation time in the observation group was significantly shorter than that in the control group[102(91,117)s VS 136(127,145)s,Z=-9.639,P<0.001].The one-time operation success rate in the observation group was significantly higher than that in the control group[88.28%(128/145)VS 67.61%(48/71),χ^(2)=13.496],the nasopharynx stimulation score[1(1,2)VS 2(1,2),Z=-4.457]and adverse events incidence[4.14%(6/145)VS 15.49%(11/71),χ^(2)=8.475]in the observation group were significantly lower than those in the control group(P<0.05).During the indwelling of nasobiliary duct,the bile drainage volume(179.45±81.54 mL VS 142.89±55.69 mL,t=3.407)and nursing satisfaction score(7.72±0.99 VS 6.06±1.07,t=11.337)in the observation group were higher than those in the control group,and the comfort score(3.00±1.01 VS 4.83±0.99,t=-12.642)and incidence of adverse events[3.45%(5/145)VS 14.08%(10/71),χ^(2)=8.344]in the observation group were lower than those in the control group(P<0.05).The operation time of nasobiliary duct removal in the observation group was significantly shorter than that in the control group(9.00±1.14 s VS 11.93±1.36 s,t=-16.616,P<0.001).In conclusion,the guide wire extraction and single reverse-αfixation with short nasobiliary duct for nasobiliary oronasal conversion and fixation in endoscopic nasobiliary drainage has the advantages of simple operation,small irritation response and low complication incidence,which is worth of clinical promotion.