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| Clinical Application Effect of Endoscopic Retrograde Cholangiopancreatography without Nasobiliary Drainage in the Treatment of Common Bile Duct Stones |
| HE Ju, HUANG Xin, QIU Xuejiao |
| Xiangxiang People's Hospital Affiliated to Changsha Medical University, Xiangtan Hunan 411400 |
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Abstract 【Objective】 To investigate the clinical application effect of endoscopic retrograde cholangiopancreatography (ERCP) without nasobiliary drainage in the treatment of common bile duct stones. 【Methods】 The clinical data of 94 patients with common bile duct stones who underwent ERCP in our hospital from January 2021 to December 2023 were retrospectively analyzed. According to whether nasobiliary drainage was placed or not, the patients were divided into the observation group (without nasobiliary drainage, n=50) and the control group (with nasobiliary drainage, n=44). The perioperative indicators, incidence of complications, residual stone rate and recurrence rate were compared between the two groups. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) before and after surgery, as well as the serum amylase (AMY) level 3 hours before and after surgery were compared between the two groups. 【Results】 The operation time, total hospitalization time and postoperative hospitalization time in the observation group were shorter than those in the control group, with statistically significant differences (P<0.05). There were no statistically significant differences in the intraoperative blood loss and Numerical Rating Scale (NRS) scores between the two groups (P>0.05). After surgery, the serum levels of ALT, AST and TBIL in both groups were lower than those before surgery, with statistically significant differences (P<0.05). There were no statistically significant differences in the serum levels of AMY, ALT, AST and TBIL between the two groups (P>0.05). There were no statistically significant differences in the incidences of postoperative abdominal infection or cholangitis, pancreatitis, gastrointestinal bleeding, hyperamylasemia and intestinal perforation between the two groups (P>0.05). There were no statistically significant differences in the postoperative residual bile duct stones and stone recurrence within half a year after surgery between the two groups (χ2=0.013, 0.033, all P>0.05). 【Conclusion】 ERCP has a good clinical effect in the treatment of common bile duct stones. On the premise of mastering the indications, the treatment scheme without nasobiliary drainage is safe and feasible.
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Received: 27 June 2025
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[1] SOUSA M, PINHO R, PROENÇA L, et al. Choledocholithiasis in elderly patients with gallbladder in situ:Is ERCP sufficient?[J].Scand J Gastroenterol,2018, 53(10-11): 1388-1392.
[2] CIANCI P, RESTINI E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches[J].World J Gastroenterol,2021, 27(28): 4536-4554.
[3] 何小东,刘齐飞.肝胆管结石的诊断与治疗[J].中华消化外科杂志,2015,14(4):275-279.
[4] 中华医学会消化内镜学分会ERCP学组, 中国医师协会消化医师分会胆胰学组, 国家消化系统疾病临床医学研究中心.中国ERCP指南(2018版)[J].中华消化内镜杂志, 2018,35(11): 777-813.
[5] 陆贤,高杰,黄永刚,等.腹腔镜手术与开腹手术治疗胆总管结石临床效益比较[J].肝胆胰外科杂志,2022,34(4): 233-236.
[6] HE M Y, ZHOU X D, CHEN H, et al. Various approaches of laparoscopic common bile duct exploration plus primary ductclosure for choledocholithiasis: a systematic review and meta-analysis [J].Hepatobiliary Pancreatic Dis Int,2018, 17(3):183-191.
[7] 陈安平, 罗聪, 严朝成,等. 同期两镜或同期三镜下胆总管探查一期缝合术2779 例 [J].肝胆胰外科杂志, 2019, 31(8):473-477.
[8] 纪麒麟.腹腔镜下胆总管探查术后一期缝合术与T管引流术治疗胆囊结石合并胆总管结石患者的临床效果[J].医疗装备,2023,36(12):62-64.
[9] 周华丁,王一飞,王正昕.内镜下鼻胆管引流术在复杂肝外胆管结石中的应用体会[J].中华肝脏外科手术学杂志,2018,7(3):181-183.
[10] 刘海潮,刘少朋,苏宝威.鼻胆管引流及引流时间对胆总管结石ERCP术后并发症的影响[J].河南医学研究,2020,29(6):1003.
[11] 廖想,周文策.经内镜鼻胆管引流术在ERCP中的应用价值[J].兰州大学学报,2022,48(2):88-91.
[12] 张林,张宁.麻醉在经内镜逆行性胰胆管造影术中的应用进展[J].中国现代医生,2024,62(6):129-132.
[13] 刘荣泉,季云,张杰气.囊扩张术与ERCP联合应用对胆总管结石患者手术效果及并发症的影响[J].中外医学研究,2024,22(6):134-137.
[14] 叶亮,李运泽,蔡怀阳.胆总管冲洗对减少胆管取石术后残石的影响[J].中国内镜杂志,2024,30(5):23-28. |
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2025, Vol. 42 
