探讨内镜下鼻胆管引流术（ENBD）在肝门部胆管癌患者术前减黄中的有效性和安全性。

回顾性分析2018年10月至2019年2月中山大学孙逸仙纪念医院行ENBD术前减黄的8例肝门部胆管癌患者临床资料。其中男6例，女2例；年龄53～74岁，中位年龄59岁。患者均签署知情同意书，符合医学伦理学规定。观察ENBD的成功率、减黄效果、并发症等情况。ENBD前后血清TB比较采用秩和检验。

8例患者均成功施行ENBD，其中左肝管引流4例，右肝管引流3例，双侧胆管引流1例。其中1例同时置入胰管支架以预防术后胰腺炎，所有患者均未行十二指肠乳头括约肌切开。ENBD操作时间中位数56（15～134）min，胆汁引流量565（248～1 235）ml/d，引流时间24（16～73）d。ENBD引流后TB为57（39～78）μmol/L，明显低于引流前的283（144～563）μmol/L（Z=-2.52，P<0.05）。ENBD术后2例发生节段性胆管炎，经抗生素治疗后痊愈，无发生胰腺炎、出血及穿孔。术前TB降至68.4 μmol/L以下者6例，降至51.3 μmol/L以下者2例。减黄后6例行R0切除，1例行R1切除，1例无法切除。1例患者术后发生腹腔感染、肝衰竭，经抗感染、护肝等支持治疗恢复；其余7例术后均恢复顺利，无发生并发症。

术前ENBD可使肝门部胆管癌患者安全、有效减黄，增加手术安全性，降低手术并发症发生率。ENBD应尽量避免行内镜下十二指肠乳头括约肌切开，必要时留置胰管支架预防术后胰腺炎。

To evaluate the efficacy and safety of endoscopic nasobiliary drainage (ENBD) in preoperative reduction of jaundice in patients with hilar cholangiocarcinoma.

Clinical data of 8 patients with hilar cholangiocarcinoma who underwent ENBD for preoperative reduction of jaundice in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from October 2018 to February 2019 were retrospectively analyzed. Among them, 6 patients were male and 2 female, aged from 53 to 74 years with a median age of 59. The informed consents of all patients were obtained and the local ethical committee approval was received. The ENBD success rate, effect of jaundice reduction and complications were observed. TB levels before and after ENBD were statistically compared by rank sum test.

ENBD was successfully performed in 8 patients including 4 cases of left hepatic duct drainage, 3 cases of right hepatic duct drainage and 1 case of bilateral duct drainage. Pancreatic duct stent was placed in 1 case to prevent postoperative pancreatitis. No patient underwent sphincterotomy of duodenal papilla. The median operation time of ENBD was 56(15-134) min, the bile drainage volume was 565(248-1 235) ml/d, the drainage time was 24(16-73) d. TB level after ENBD was 57(39-78) μmol/L, significantly lower than 283(144-563) μmol/L before ENBD (Z=-2.52, P<0.05). Segmental cholangitis occurred in 2 cases after ENBD, who were cured after antibiotic treatment. No pancreatitis, hemorrhage or perforation was observed. Preoperatively, TB level was decreased to below 68.4 μmol/L in 6 patients and below 51.3 μmol/L in 2 cases. After jaundice reduction, 6 cases underwent R0 resection, 1 case received R1 resection, and the tumor could not be resected in 1 case. One patient developed abdominal infection and liver failure after operation, who was recovered after anti-infection and liver protection therapy. The remaining 7 patients were well recovered without postoperative complications.

Preoperative ENBD is an efficacious and safe approach to reduce jaundice in patients with hilar cholangiocarcinoma, which can increase surgical safety and reduce the incidence of surgical complications. During ENBD, endoscopic sphincterotomy of duodenal papilla should be avoided. Pancreatic duct stent should be placed when necessary to prevent the postoperative pancreatitis.