Application Of Endoscopic Balloon Nasobiliary Drainage In The Treatment Of Secondary Common Bile Duct Stones

Objective: Through comparative analysis of simultaneous triple-scopy(laparoscopy,choledochoscopy,duodenoscope)Endoscopic balloon nasobiliary drainage(ENBD)and two-scopy(laparoscopy,choledochoscopy)combined with direct primary suture for the treatment of secondary common bile ducts Perioperative data of stones,to explore the clinical application value of simultaneous triple-scopy ENBD in the treatment of secondary common bile duct stones.Methods: A retrospective analysis of 213 patients diagnosed with gallbladder stones combined with secondary common bile duct stones in Chengdu Hospital(Chengdu Second People’s Hospital)of Zunyi Medical University between January 2017 and December 2019,according to Whether to perform ENBD patients were divided into two groups,including 115 cases in the ENBD group and 98 cases in the non-drained group.This study collected the general information of the two groups of cases,including gender,age,preoperative nutritional indicators(body mass index,albumin),preoperative liver function(ALT,AST,TBIL,DBIL),cholangitis grade,common bile duct diameter,The size and number of common bile duct stones,whether they are combined with basic diseases such as hypertension,diabetes,and chronic obstructive pulmonary disease;intraoperative and postoperative related conditions,including operation method,operation time,intraoperative blood loss,hospitalization expenses,postoperative hospitalization time,Abdominal drainage time,gastrointestinal function recovery time,liver function(ALT,AST,TBIL,DBIL)on the third postoperative day,postoperative complications(operating field bleeding,abdominal abscess,bile leakage,postoperative pancreatitis,residual stones,Electrolyte disorders),follow-up for 3-6 months.This research uses SPSS 20.0 software to conduct statistical analysis on the collected data.Results: Both groups of patients finished the operation successfully without death.In the general preoperative data,there was no significant difference in gender,age,preoperative nutritional indicators(body mass index,albumin),preoperative liver function,and comorbidities(P>0.05).Intraoperative data showed that the operation time of the ENBD group and the non-drainage group were 100(20)min and 85(15)min respectively,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in both intraoperative blood loss and intraoperative hydroelectric lithotripsy(P>0.05).In the postoperative data,the abdominal drainage time of the ENBD group and the non-drainage group was4(1)days and 5(1)days respectively,and the difference was statistically significant(P<0.05);The post-hospitalization time of the ENBD group and the non-drainage group were operated was 8(1)days and 7(2)days respectively,the difference was statistically significant(P<0.05);the hospitalization expenses of the ENBD group and the non-drained group were 27654(5434)Yuan and 24254(5333)Yuan,the difference was statistically significant(P<0.05).There was no significant difference in gastrointestinal function recovery time,△ALT,△AST,△TBIL,△DBIL between the ENBD group and the non-drainage group(P>0.05).In the data of postoperative complications,the postoperative bile leakage in ENBD group was significantly less than the non-drained group,with 2(1.7%)cases and 10(10.2%)cases respectively,the difference was statistically significant(P<0.05).The postoperative residual stones in the ENBD group were slightly less than those in the non-drained group,with 2(1.7%)cases and 7(7.1%)cases respectively,and the difference was not statistically significant(P>0.05).There was no significant difference in postoperative hemorrhage,abdominal abscess,postoperative pancreatitis,and total complication rate between the ENBD group and the non-drainage group(P>0.05).The drainage of the nasal bile duct showed that the postoperative ENBD was not broken or blocked so that there is no fluid to flow out.In the ENBD group,the average drainage volume was(223±85)ml,(230±95)ml,and(251±103)ml in the three-day postoperative period.The Balloon nasobiliary ducts in two cases were removed accidentally and unplannedly due to patient activity.Close observation after removal abdominal signs and vital signs showed no adverse reactions and patients were discharged from the hospital.The remaining patients had a nasocholangiogram 5 to 7 days after surgery,and the balloon nasobiliary duct was removed 5 to 13 days after surgery.All patients in the group were followed up for 3 to 6 months.In the non-drainage group,7 cases of residual stones in the common bile duct were found within 1 to 3 months after surgery.No severe postoperative complications such as biliary stricture were found in all patients.Conclusion: Simultaneous three-scopy ENBD did not increase the overall postoperative complication rate,significantly reduced the incidence of bile leakage and shortened the time of abdominal drainage,but the rate of residual stones did not decrease significantly.In summary,the simultaneous triple-scopy ENBD has certain clinical application value in the treatment of secondary common bile duct stones.In the case of strict screening of cases,It is a safe,effective and feasible surgical approach.