摘要
目的探讨腹腔镜、十二指肠镜和胆道镜多镜联合在肝内外胆管结石治疗中的应用价值。方法回顾性分析2007年4月至2010年8月吉林大学白求恩第一医院收治的316例肝内外胆管结石患者的临床资料。其中胆囊结石合并胆总管结石269例，胆囊结石合并胆总管结石伴肝内胆管结石10例，胆总管结石37例。对于胆总管直径≥10mm或伴肝内胆管结石的患者行Lc＋腹腔镜胆总管探查（LCBDE）＋胆道镜取石术；对于胆总管直径〉5mm／1且〈10mm、胆囊管直径〈5mm的患者行EST＋Lc或Lc＋EST；对于胆总管直径≤5mm、胆囊管直径≥5mm的患者行Lc＋经胆囊管途径胆总管探查＋胆道镜取石术。结果本组306例患者成功取石，取石成功率为96．8％（306／316）。163例行Lc＋LCBDE＋T管引流＋胆道镜取石术，平均手术时间为93．6min，平均住院时间为9．8d，平均住院费用为2．8万元，5例患者术后出现并发症。54例患者行EST＋LC，平均手术时间为45．0min，平均住院时间为6．6d，平均住院费用为2．3万元，1例患者术后出现并发症。67例患者行LC＋EST，平均手术时间为40．0min，平均住院时间为6．1d，平均住院费用为2．4万元，2例患者术后出现并发症。32例患者行胆总管一期缝合及Lc＋经胆囊管途径胆总管探查＋胆道镜取石术。平均手术时间为97．3min，平均住院时间为7．3d，平均住院费用2．5万元，1例患者术后出现并发症。272例患者术后平均随访12个月，6例患者术后胆总管结石复发，其余患者未发现残留结石及胆管狭窄。结论腹腔镜、十二指肠镜和胆道镜三镜联合治疗肝内外胆管结石具有创伤小、恢复快及并发症少的优点。
Objective To investigate the application of laparoseope, duodenoscope and eholedoehoseope in the treatment of intra- and extrahepatie bile duet stone. Methods The clinical data of 316 patients with intra- and extrahepatic bile duct stone who were admitted to the Bethune First Hospital from April 2007 to August 2010 were retrospectively analyzed. There were 269 patients with eholecystolithiasis and choledocholithiasis, 10 patients with cholesystolithiasis, choledocholithiasis and hepatolithiasis, and 37 patients with choledocholithiasis. Laparo- scopie choleeystectomy （LC） ＋ laparoseopic common bile duet exploration （LCBDE） ＋ choledoehoscopy was applied to patients with hepatolithiasis or with the diameter of common bile duct ≥10 mm; endoscopic sphincterotomy （EST） ＋ LC or LC ＋ EST was applied to patients with the diameter of common bile duet between 10 mm and 5 mm and the diameter of cystic duet 〈 5 mm; LC ＋ laparoscopie transeystie common bile duet exploration （TC-CBDE） ＋ eholedochoscopy was applied to patients with the diameter of common bile duct≤5 mm and the diameter of cystic duct≥5 ram. Results The success rate of operation was 96.8% （306/316）. A total of 163 patients received LC ＋ LCBDE ＋ T-tube drainage ＋ choledochoseopy, and the mean operation time, expense, duration of hospital stay were 93.6 minutes, 2.8×10^4 yuan and 9.8 days, respectively, and 5 patients had complications postoperatively. Fifty-four patients received EST ＋ LC, and the mean operation time, expense, duration of hospital stay were 45.0 minutes, 6.6 days, 2.3 ×10^4 yuan, respectively, and 1 patient had complication postoperatively. Sixty-seven patients received LC ＋ EST, and the mean operation time, expense and duration of hospital stay were 40.0 minutes, 6. 1 days, 2.4×10^4 yuan, respectively, and 2 patients had complication postoperatively. Thirty-two patients received one-stage repair of common bile duct and LC ＋ TC-CBDE ＋ choledochoscopy, and the mean operation time, expense and duration of hospital stay were 97.3 minutes, 7.3 days and 2.5×10^4 yuan, respectively, and 1 patient had complication postoperatively. A total of 272 patients were followed up for 12 months, except for 6 patients with recurrence of common bile duct stone, no residual stone or biliary stricture was detected. Conclusion Combined application of laparoscope, duodenoscope and choledochoscope has advantages of less trauma, quick recovery and fewer complications in the treatment of intra- and extrahepatic bile duct stone.
出处
《中华消化外科杂志》
CAS
CSCD
2011年第3期179-181,共3页
Chinese Journal of Digestive Surgery
