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改良内镜鼻胆管负压引流治疗手术后胆瘘 |
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孙志为 付德庄 莫一我 金焰 朱秀芳 张新俊 乔欧
［摘要］ 目的 改进胆瘘的治疗效果，降低并发症发生率和死亡率。方法 根据胆瘘发病的病理生理和解剖特点，用改良内镜鼻胆管(MENBD)负压引流的方法，对6例术后持续胆瘘进行治疗。结果 使保守治疗6～90 d未愈的胆瘘在6～15 d闭合。结论 MENBD治疗胆瘘，具有保留Oddi扩约肌生理功能，造影显示胆管解剖和胆瘘部位，效果确切，安全，并发症少，避免再次手术，明显缩短住院时间和降低医疗费用等优点。
［关键词］ 改良鼻胆管； 治疗； 胆瘘
［中图分类号］ R657.4 ［文献标识码］ A
［文章编号］ 1005-6483(2000)03-0144-02
The management of postoperative bile fistulas by modified endoscopic nasobilliary duct negative pressure drainage
SUN Zhiwei,FU Dezhuang,MO Yiwo
（Department of Hepatobilillary,The First People s Hospital of Yunnan Province,Kunming 650032，China）
［Abstract］ Objective In order to improve the treating effect,decrease the rates of complication and mortality.Methods Based on the characteristic of pathology and anatomy,the authors managed 6 patients of postoperative bile fistulas with modified endoscopic nasobilliary duct negative pressure drainage.Results The 6～15 day in course of treatment ,the leakage were blocked,the patients were not yet recovered after 6～90 day with conservative treatment.Conclusions The authors thought that the advantages of endoscopic nasobilliary duct drainage curing postoperative bile fistulas:a.Retain the function of the Oddi s sphincter.b.Can clearly show the anatomy of pancreatobilliary duct and the position of pancreatic fistulas with pancreatography.c.The draining effect was certin,dependable safe and less complication,avoiding reoperation.d.Can urge the leakage blocked with the drainage of negative pressure aspiration.e.Shorten the times in hospital and reduce medicinal fee obviously.
［Key words］ Modified nasobilliary duct; Management; Bile fistulas
我院1994年1月至1999年8月，用改良内镜鼻胆管引流(modified endoscopic nasobilliary drainage,MENBD)［1］治疗6例术后持续胆瘘患者，取得满意效果，现总结报道如下。
资料与方法
一、一般资料：手术后胆瘘6例，男性2例，女性4例，年龄24～67岁。胆囊切除术后胆总管针眼瘘1例，胆囊切除术后胆囊颈管残端瘘2例，胆总管切开取石术后拔“T”管窦道破裂致胆瘘1例，肝脏部分切除术后胆瘘2例。术前准备与常规逆行胰胆管造影(ERC[1] [2] 下一页
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