目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结...目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结石的临床效果。方法选择2011年6月-2013年6月在新疆医科大学第一附属医院行腹腔镜胆总管探查取石术的58例继发性肝外胆管结石患者,分为两组,LTCBDE组26例,LCBDE组32例(其中2例为LTCBDE组术中中转)。比较两组患者手术时间、术中出血量、住院费用、术后补液量、术后带管时间、术后住院时间及术后并发症(胆漏、胆总管狭窄、胆管炎、腹腔感染、胆道出血、残余结石)。结果两组患者手术均成功,治愈后出院,无死亡病例。LTCBDE组术后无胆漏、残余结石及胆道出血,LCBDE组术后出现1例胆漏、2例残余结石、1例胆道出血,两组均无术后胆总管狭窄、胆管炎及腹腔感染病例。LTCBDE组患者术后带管时间、住院费用、术中出血量、术后住院时间、术后补液量均少于LCBDE引流组,差异有统计学意义(P<0.05);LTCBDE组手术时间长于LCBDE组,差异有统计学意义(P<0.05)。结论在严格掌握手术适应证的条件下,LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,可视为安全有效及经济的术式选择。展开更多
目的:探讨液电碎石联合胆道镜在经胆囊管腹腔镜胆道探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)中的应用技巧及效果.方法:回顾分析24例LTCBDE患者临床资料,术前均经磁共振胰胆管成像(magnetic resonance cho...目的:探讨液电碎石联合胆道镜在经胆囊管腹腔镜胆道探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)中的应用技巧及效果.方法:回顾分析24例LTCBDE患者临床资料,术前均经磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)确诊胆囊结石合并胆管结石,胆管结石直径≥1.6 cm,记录手术时间,住院时间及术后并发症发生率.结果:手术均获成功,无1例中转开腹.手术时间75-210 min,住院时间3-7 d,1例(4.2%)发生胆管残余结石,自行排出.结论:液电碎石联合胆道镜应用于LTCBDE可在具备适应症情况下安全有效处理较大胆管结石,是治疗胆管结石较好方法之一.展开更多
AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4...AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis(clinical ascending cholangitis, common bile duct(CBD) stones on ultrasonography(US), total bilirubin > 4 mg/d L, dilated CBD on US, total bilirubin 1.8-4 mg/d L, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ2 to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis(P = 0.063), all other predictors of cho-ledocholitiasis(clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group(79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2%(25/73 patients) and 0(0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients' selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily.展开更多
文摘目的比较分析腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流(laparoscopic common bile duct exploration,LCBDE)2种术式治疗继发性肝外胆管结石的临床效果。方法选择2011年6月-2013年6月在新疆医科大学第一附属医院行腹腔镜胆总管探查取石术的58例继发性肝外胆管结石患者,分为两组,LTCBDE组26例,LCBDE组32例(其中2例为LTCBDE组术中中转)。比较两组患者手术时间、术中出血量、住院费用、术后补液量、术后带管时间、术后住院时间及术后并发症(胆漏、胆总管狭窄、胆管炎、腹腔感染、胆道出血、残余结石)。结果两组患者手术均成功,治愈后出院,无死亡病例。LTCBDE组术后无胆漏、残余结石及胆道出血,LCBDE组术后出现1例胆漏、2例残余结石、1例胆道出血,两组均无术后胆总管狭窄、胆管炎及腹腔感染病例。LTCBDE组患者术后带管时间、住院费用、术中出血量、术后住院时间、术后补液量均少于LCBDE引流组,差异有统计学意义(P<0.05);LTCBDE组手术时间长于LCBDE组,差异有统计学意义(P<0.05)。结论在严格掌握手术适应证的条件下,LTCBDE具有创伤小、并发症少、费用低、术后生活质量高等优点,可视为安全有效及经济的术式选择。
文摘目的:分析晚期恶性梗阻性黄疸的三种姑息性引流方法的临床疗效。方法 :回顾性分析我院2010年3月至2012年7月58例晚期恶性梗阻性黄疸病人的临床资料。按照治疗方法分为3组:胆肠内引流组16例,经皮肝穿刺胆管支架置入(percutaneous transhepatic biliary stent,PTBS)组18例,内镜胆管金属支架引流(endoscopic bile duct metal stents drainage,EBMSD)组24例。观察3组治疗前后的血胆红素、丙氨酸转氨酶水平,并随访生存时间。结果:引流1周后,3组总胆红素及直接胆红素水平均较术前明显下降(P<0.05),但各组总胆红素水平的下降程度无统计学差异(P>0.05),3组间谷氨酸转氨酶等肝功能指标恢复情况及生存时间无统计学差异(P>0.05)。胆肠内引流组术后胃肠道功能恢复时间较另两组明显延长(P<0.05),EBMSD组术后并发症发生率较另外两组更低。结论:相对于传统开腹胆肠内引流术,EBMSD和PTBS具有微创及全身情况恢复快等优点,但PTBS由于其并发症发生率相对较高,可在内镜治疗失败后考虑应用。EBMSD治疗的适应证广,并发症发生率低。
文摘AIM: To study the practical applicability of the American Society for Gastrointestinal Endoscopy guidelines in suspected cases of choledocholithiasis.METHODS: This was a retrospective single center study, covering a 4-year period, from January 2010 to December 2013. All patients who underwent endoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included. Based on the presence or absence of predictors of choledocholithiasis(clinical ascending cholangitis, common bile duct(CBD) stones on ultrasonography(US), total bilirubin > 4 mg/d L, dilated CBD on US, total bilirubin 1.8-4 mg/d L, abnormal liver function test, age > 55 years and gallstone pancreatitis), patients were stratified in low, intermediate or high risk for choledocholithiasis. For each predictor and risk group we used the χ2 to evaluate the statistical associations with the presence of choledocolithiasis at ERCP. Statistical analysis was performed using SPSS version 21.0. A P value of less than 0.05 was considered statistically significant. RESULTS: A total of 268 ERCPs were performed for suspected choledocholithiasis. Except for gallstone pancreatitis(P = 0.063), all other predictors of cho-ledocholitiasis(clinical ascending cholangitis, P = 0.001; CBD stones on US, P ≤ 0.001; total bilirubin > 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001; dilated CBD on US, P ≤ 0.001; abnormal liver function test, P = 0.012; age > 55 years, P = 0.002) showed a statistically significant association with the presence of choledocholithiasis at ERCP. Approximately four fifths of patients in the high risk group(79.8%, 154/193 patients) had confirmed choledocholithiasis on ERCP, vs 34.2%(25/73 patients) and 0(0/2 patients) in the intermediate and low risk groups, respectively. The definition of "high risk group" had a sensitivity of 86%, positive predictive value 79.8% and specificity 56.2% for the presence of choledocholithiasis at ERCP. CONCLUSION: The guidelines should be considered to optimize patients' selection for ERCP. For high risk patients specificity is still low, meaning that some patients perform ERCP unnecessarily.
