基于短鼻胆管导丝引出法探讨自制引导器在鼻胆管口鼻转换中的应用价值

Application value of self-made guide device in nasobiliary conversion based on the short nasobiliary duct and guide wire extraction method

摘要:

目的 基于短鼻胆管导丝引出法探讨自制引导器在鼻胆管口鼻转换中的应用价值。方法 回顾性分析2021年5月－2021年6月同济大学附属东方医院120例行内镜下鼻胆管引流术（ENBD）患者的临床资料，根据引导器的类型分为：A组（乳头扩张球囊导管头端制作引导器，n = 60）、B组（取石球囊导管头端制作引导器，n = 40）和C组（不使用引导器，n = 20）。比较3组患者鼻胆管引出时间，患者对刺激的反应程度评分以及鼻黏膜出血发生率。结果 A组鼻胆管引出时间为（5.13±0.85）s，B组为（7.20±0.88）s，C组为（11.30±1.42）s，3组患者比较，差异有统计学意义（F = 303.04，P = 0.000）；A组对刺激的反应程度评分为1.00（1.00，1.00）分，B组为2.00（1.00，2.00）分，C组为2.00（2.00，3.00）分，3组患者比较，差异有统计学意义（Z = 47.89，P = 0.000）；A组鼻黏膜出血率1.67%（1/60），B组为20.00%（8/40），C组为40.00%（8/20），3组患者比较，差异有统计学意义（χ² = 19.81，P = 0.000）。结论 采取短鼻胆管导丝引出法行鼻胆管口鼻转换时，使用乳头扩张球囊导管制作引导器，可加快鼻胆管引出速度，减轻患者不适反应，减少鼻黏膜副损伤，值得临床推广。

Abstract:

Objective To investigate the value of self-made guide device in nasobiliary conversion based on the short nasobiliary duct and guide wire extraction method.Methods The clinical data of 120 patients who underwent endoscopic nasobiliary drainage from May to June 2021 were analyzed retrospectively. According to the type of self-made guide device, the patients were divided into group A (balloon catheter for nipple dilatation, n = 60), group B (balloon catheter for lithotomy, n = 40) and group C (without self-made guide device, n = 20). The extraction time of nasobiliary duct, the score of patients' response to stimulation and the incidence of nasal mucosal bleeding were compared among the three groups.Results The extraction time of nasobiliary duct in the group A was (5.13 ± 0.85) s, it was (7.20 ± 0.88) s in the group B, (11.30 ± 1.42) s in the group C and the difference was significant (F = 303.04, P = 0.000). The score of patients' response to stimulation in the group A was 1.00 (1.00, 1.00), it was 2.00 (1.00, 2.00) in the group B, 2.00 (2.00, 3.00) in the group C, and the difference was significant (Z = 47.89, P = 0.000). The incidence of nasal mucosal bleeding in the group A was 1.67% (1/60), it was 20.00% (8/40) in the group B, 40.00% (8/20) in the group C, and the difference was significant (χ² = 19.81, P = 0.000).Conclusion When the short nasobiliary duct and guide wire extraction method is used for nasobiliary conversion, the nipple dilatation balloon catheter should be used to make the guide device, which can speed up the extraction speed of nasobiliary duct, reduce the discomfort reaction of patients and the side injury of nasal mucosa, and is worthy of clinical promotion.