内镜逆行胰胆管造影联合内镜下鼻胆管引流时限差异对Mirizzi综合征外科治疗的临床应用价值

Comparative study of endoscopic retrograde cholangiopancreatography combined with nasal bile duct drainage at different drainage times in surgical treatment of Mirizzi syndrome

摘要:

目的 探讨内镜逆行胰胆管造影（ERCP）联合内镜下鼻胆管引流术（ENBD）引流时限差异对Mirizzi综合征外科治疗的临床应用价值。方法 采用回顾性队列研究收集2008年10月－2018年9月37例在浙江大学医学院附属杭州市第一人民医院接受ENBD及外科手术治疗的Mirizzi综合征患者的资料，按引流时间（7 d为界）分为短时组（≤ 7 d，n = 19）和长时组（ > 7 d，n = 18），比较两组外科手术前胆红素情况、术中术式变化、术后并发症发生率、住院天数和治疗费用等情况。结果 短时组胆红素下降幅度为4.40（0.00，25.20）mmol/L，明显小于长时组的33.55（5.18，87.33）mmol/L（Z = -2.05，P = 0.040）；两组各5例腹腔镜转开腹手术；短时组术后感染发生率15.8%（3/19）较长时组（0.0%）高，但两组比较，差异无统计学意义（􀱽² = 3.09，P = 0.079）；虽然长时组住院时间较短时组略长，但并未增加住院总费用。结论 ERCP联合ENBD引流时间延长（ > 7 d）可增加胆红素下降程度，同时可能降低Mirizzi综合征外科术后感染率，且不增加住院费用，值得临床借鉴。

Abstract:

Objective To investigate the contrast value of endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic naso-biliary duct drainage (ENBD) on the difference of drainage time before surgical treatment of Mirizzi syndrome.Methods A retrospective cohort study was used to collect 37 patients with Mirizzi syndrome who underwent ENBD and surgical treatment from October 2008 to September 2018. All the patients were divided into two groups: short-term group (≤7 d, n = 19) and long-term group ( > 7 d, n = 18). Compare the bilirubin status before surgery, intraoperative changes in surgery, the incidence of postoperative complications, and the length of hospital stay and treatment costs.Results The bilirubin in the short-term group decreased 4.40 (0.00, 25.20) mmol/L, which was significantly less than the long-term group 33.55 (5.18, 87.33) mmol/L (Z = -2.05, P = 0.040); 5 patients in each group switched to open abdominal surgery. The incidence of postoperative infection was 15.8% (3/19) in short-term group and higher in long-term group (0.0%), but the difference was not statistically significant（􀱽² = 3.09，P = 0.079）; Although the length of stay in the long-term group was shorter than that of the short-time group, the total cost of hospitalization was not increased.Conclusion Prolonged drainage time ( > 7 d) of ERCP combined with ENBD can increase the reduction of bilirubin, and at the same time may reduce the postoperative infection rate of Mirizzi syndrome without increasing the cost of patients, which is worthy of clinical reference.