Fujii Masakazu, Okino Motonori, Fujioka Kentaro, Yamashita Katsuyuki, Hamano Kimikazu
Department of Surgery, Onoda City Hospital, 1863-1 Higashitakatomari, Onoda, Yamaguchi 756-0094, Japan.
J Hepatobiliary Pancreat Surg. 2005;12(5):386-90. doi: 10.1007/s00534-005-0984-1.
We devised a procedure for the placement of a double-pigtail endoscopic retrograde biliary drainage (ERBD) tube as an alternative to the placement of a T-tube. We used the procedure, after primary closure of the common bile duct, in three patients undergoing surgery for choledocholithiasis. All three patients were in their eighties, and all were diagnosed with cholecystolithiasis and choledocholithiasis. In all three, there were concerns about possible complications with the use of a T-tube. Two of the patients were senile and were thought to be likely to pull out the tube, and incomplete fistulation was considered possible in the third patient. Thus, there was an increased risk of bile peritonitis in all three patients. Placement of the ERBD tube was successful in all three patients, and there were no postoperative complications. The hospital stay was a few weeks shorter than the usual stay with the placement of a T-tube. We conclude that primary closure of the common bile duct with the placement of a double-pigtail ERBD tube is clinically safe and advantageous for choledocholithiasis patients with senile dementia and for patients with possible incomplete fistulation.
我们设计了一种双猪尾内镜逆行胆管引流（ERBD）管置入术，作为T管置入术的替代方法。我们在胆总管一期缝合后，对3例因胆总管结石接受手术的患者采用了该方法。所有3例患者均为80多岁，均被诊断为胆囊结石和胆总管结石。在这3例患者中，均担心使用T管可能出现并发症。其中2例为老年患者，被认为可能会拔出T管，第3例患者则被认为可能出现瘘管形成不完全的情况。因此，这3例患者发生胆汁性腹膜炎的风险均增加。所有3例患者ERBD管置入均成功，且无术后并发症。住院时间比常规置入T管的住院时间短几周。我们得出结论，对于患有老年痴呆症的胆总管结石患者以及可能存在瘘管形成不完全的患者，胆总管一期缝合并置入双猪尾ERBD管在临床上是安全且有益的。
