Wang H P, Huang S P, Sun M S, Chen J H, Wang H H, Lin C C, Chang Y S, Yang C S, Wu M S, Lin J T
Departments of Emergency Medicine and Internal Medicine, National Taiwan University Hospital, Taipei.
Gastrointest Endosc. 2000 Dec;52(6):741-4. doi: 10.1067/mge.2000.109800.
Endoscopic nasobiliary drainage (ENBD) is routinely performed under fluoroscopic control. This is a report of our experience with urgent ENBD without fluoroscopic guidance in critically ill patients.
Twenty-six critically ill patients who underwent urgent ENBD for biliary obstruction were analyzed. ENBD was performed without fluoroscopic control because of high risk of transportation or inaccessibility of the x-ray facilities. A pig-tailed nasobiliary catheter was inserted into the bile duct with the help of a guidewire under endoscopic control to bypass the site of obstruction. Successful placement was confirmed by free flow of bile on aspiration via the nasobiliary catheter.
A nasobiliary catheter was successfully placed in 23 patients (88%). Adequate bile drainage was achieved in 20 patients with an overall success rate of 77%. There were no procedure-related complications. The mortality rate for patients with successful biliary drainage was 10% (2 of 20), in contrast to 83% (5 of 6) for the group in which drainage was unsuccessful.
Urgent ENBD is effective for patients with biliary obstruction. With experience, this procedure may be successfully performed in critically ill patients without fluoroscopic guidance at primary care hospitals or intensive care units where fluoroscopic facilities are not readily available.
内镜下鼻胆管引流术（ENBD）通常在荧光透视引导下进行。本文报告了我们在重症患者中无荧光透视引导下进行紧急ENBD的经验。
分析了26例因胆道梗阻接受紧急ENBD的重症患者。由于转运风险高或无法使用X线设备，ENBD在无荧光透视引导下进行。在内镜控制下借助导丝将猪尾状鼻胆管导管插入胆管，以绕过梗阻部位。通过经鼻胆管导管抽吸胆汁通畅来确认导管成功置入。
23例患者（88%）成功置入鼻胆管导管。20例患者实现了充分的胆汁引流，总体成功率为77%。无手术相关并发症。胆汁引流成功的患者死亡率为10%（20例中的2例），而引流不成功的患者组死亡率为83%（6例中的5例）。
紧急ENBD对胆道梗阻患者有效。凭借经验，在基层医院或重症监护病房等无法轻易获得荧光透视设备的地方，该手术可在无荧光透视引导下成功用于重症患者。
