三镜联合鼻胆管引流术与两镜T管引流在急性重症胆管炎中的疗效比较

Comparison of effects between tri-endoscopy combined with endoscopic nasobiliary drainage and two-endoscopy T-tube drainage in acute severe cholangitis

目的探讨急诊同期三镜(腹腔镜、胆道镜、十二指肠镜)联合鼻胆管引流术(ENBD)治疗急性重症胆管炎的临床应用价值。方法选取2018年1月至2023年12月该院收治的56例胆总管结石合并急性重症胆管炎患者为研究对象,根据手术方式的不同分为鼻胆管组(n=24)和T管组(n=32),鼻胆管组采用同期三镜联合ENBD,T管组采用两镜(腹腔镜、胆道镜)置入T管引流。比较两组术中、术后及并发症发生情况。结果与T管组比较,鼻胆管组带管时间更短,术后第1、2、3天胆汁引流量更少,差异有统计学意义(P<0.05)。两组均完成手术并成功置管,所有患者顺利出院,无死亡病例。鼻胆管组电解质紊乱发生率低于T管组(4.2%vs.21.9%),差异有统计学意义(P<0.05)。术后随访6~12个月,共48例复查腹部彩超或磁共振胰胆管造影(MRCP),复查率为85.7%,均未出现胆道狭窄、再生结石、胆管炎等远期并发症。结论急诊同期三镜联合ENBD治疗部分胆总管结石合并急性重症胆管炎安全、有效。

Objective To investigate the clinical application value of simultaneous three-endoscope(laparoscope,choledochoscope and duodenoscope)combined with endoscopic nasobiliary drainage(ENBD)in the treatment of acute severe cholangitis.Methods A total of 56 patients with choledocholithiasis complicating acute severe cholangitis admitted and treated in this hospital from January 2018 to December 2023 were selected as the study subjects and divided into the nasobiliary duct group(n=24)and the T tube group(n=32)according to the different drainage methods.The nasobiliary duct group adopted the simultaneous three-endoscope combined with ENBD,the T tube group adopted the two-endoscope(laparoscopy and choledochoscope)T tube placement for drainage.The intraoperative and postoperative complications occurrence situation was compared between the two groups.Results Compared with the T tube group,the tube indwelling time in the nasobiliary duct group was shorter compared with the T tube group,the bile drainage volume on postoperative 1,2,3 d was less,and the differences were statistically significant(P<0.05).The two groups all completed the operation and successfully placed the tube.All patients were smoothly discharged without death case.The electrolyte disturbance occurrence rate in the nasobiliary duct group was lower than that in the T tube group(4.2%vs.21.9%),and the difference was statistically significant(P<0.05).The postoperative follow up lasted for 6-12 months.A total of 48 cases conducted the abdominal color ultrasound examination or magnetic resonance cholangiopancreatography(MRCP),the re-examination rate was 85.7%,no long-term complications such as biliary stricture,regenerating stone and cholangitis were found.Conclusion Simultaneous laparoscopy,choledochoscopy and duodenoscopy combined with ENBD in emergency is safe and effective in the treatment of partial cases of choledocholithiasis complicating acute severe cholangitis.