简介：【摘要】 目的:探讨临床十二指肠镜下鼻胆管引流术(ENBD)和腹腔镜胆总管探查取石术（LCBDE)并胆管一期缝合与放置T管治疗肝外胆管结石引起的急性梗阻性化脓性胆管炎的疗效。方法 :对81例肝外胆管结石引起的急性梗阻性化脓性胆管炎患者均在急诊行十二指肠镜下鼻导管引流术，所有手术病人随机分成A组（41例，并行胆总管一期缝合）、B组（40例，予以放置T管引流）。结果：A、B两组在术中出血量、术后引流时间、术后胆漏发生率均无统计学意义（p0.05）,而在手术时间、胃肠功能恢复、术后住院时间方面A组更具优势(p0.05)。结论：行急诊鼻胆管引流术和择期腹腔镜胆总管探查取石术并行胆管一期缝合治疗肝外胆管结石引起的急性梗阻性化脓性胆管炎术具有安全、有效等优点。 【关键词】 急性梗阻性化脓性胆管炎 肝外胆管结石 鼻胆管引流术 [Abstract] Objective: To investigate the clinical efficacy of duodenoscopic nasobiliary drainage (ENBD) and laparoscopic choledocholithotomy （LCBDE）combined with primary suture and placement of T-tube in the treatment of acute obstructive suppurative cholangitis caused by extrahepatic bile duct stones. Methods: 81 patients with acute obstructive suppurative cholangitis caused by extrahepatic bile duct stones underwent duodenoscopic nasal catheter drainage in emergency. All patients were randomly divided into group A (41 cases with primary suture of common bile duct) and group B (40 cases with T-tube drainage). Results: the amount of intraoperative bleeding, postoperative drainage time and the incidence of postoperative bile leakage in group A and B were not statistically significant (P0.05), but group A had more advantages in operation time, gastrointestinal function recovery and postoperative hospital stay (P0.05). Conclusion: emergency nasobiliary drainage and selective laparoscopic choledocholithotomy combined with primary suture of bile duct are safe and effective in the treatment of acute obstructive suppurative cholangitis caused by extrahepatic bile duct stones.

简介：摘要目的对比分析经皮经肝胆管引流(PTCD)与内镜鼻胆管引流(ENBD)减轻黄疸对腹腔镜胰十二指肠切除术(LPD)患者围手术期的影响。方法回顾性分析2016年1月至2020年12月河北医科大学第二医院收治的173例减黄后行LPD患者的临床资料，其中男性100例，女性73例，年龄(60.4±10.8)岁。根据减黄方式不同分为PTCD组(n＝126)和ENBD组(n＝47)。比较分析两组患者的手术时间、术中出血量及输血量、R0切除率、术后并发症等临床资料。结果两组患者均顺利完成LPD，无中转开腹病例。两组患者行LPD的手术时间、术中出血量及输血量、R0切除率、肿瘤性质、住院时间比较差异无统计学意义(P>0.05)。术后PTCD组胰瘘发生率10.3%(13/126)低于ENBD组25.5%(12/47)，差异有统计学意义(P＝0.011)。PTCD组术后出血发生率8.7%(11/126)低于ENBD组25.5%(12/47)，差异有统计学意义(P＝0.004)。两组患者并发症Clavien-Dindo系统分级比较，差异有统计学意义(P＝0.008)。结论对于合并黄疸拟行LPD的患者，术前行PTCD减黄较ENBD减黄可降低LPD术后胰瘘发生率及术后出血的风险，更有利于术后恢复。