目的分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)分别联合腹腔镜经胆囊管胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)与内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatog...目的分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)分别联合腹腔镜经胆囊管胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)与内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗胆囊结石合并胆总管结石的临床疗效。方法回顾性分析2016年7月至2021年7月上海市徐汇区中心医院收治的胆总管结石合并胆囊结石病人的临床治疗,采用倾向性评分匹配法将符合入组标准的LTCBDE+LC组病人与同期行ERCP+LC组病人进行匹配,每组纳入30例,比较两组间围手术期并发症、手术时间、检验指标及随访结石复发情况。结果两组病人均无围手术期死亡;同期ERCP+LC组发生1例术后高淀粉酶血症,经保守治疗后好转,术后并发症差异无统计学意义(P>0.05);LTCBDE+LC组与ERCP+LC组比较,所用手术时间[(95.40±21.40)min比(94.01±20.37)min]差异无统计学意义(P>0.05);术后第1天总胆红素[(29.20±4.15)μmol/L比(30.25±3.91)μmol/L]、直接胆红素[(10.55±3.56)μmol/L比(11.40±4.41)μmol/L]、丙氨酸转氨酶[(27.95±5.92)U/L比(28.55±5.71)U/L]差异均无统计学意义(均P>0.05);术后3个月复查磁共振胰胆管造影、超声检查均无结石复发、残留及胆管狭窄。结论LTCBDE+LC与ERCP+LC治疗胆囊结石合并胆总管结石均安全可靠;术前严格选择适应证,LTCBDE+LC在治疗方面是更值得推广的比较好的方法。展开更多
目的总结腹腔镜下胆囊切除术（1aparoscopic cholecystectomy,LC）＋腹腔镜经胆囊管胆道探查术（laparoscopic transcystic common bile duct exploration,LTCBDE）治疗胆囊结石合并胆总管结石的经验。方法回顾性分析我院2012年3月至201...目的总结腹腔镜下胆囊切除术（1aparoscopic cholecystectomy,LC）＋腹腔镜经胆囊管胆道探查术（laparoscopic transcystic common bile duct exploration,LTCBDE）治疗胆囊结石合并胆总管结石的经验。方法回顾性分析我院2012年3月至2015年10月49例采用LC＋LTCBDE治疗胆囊结石合并胆总管结石的临床资料。结果所有病例手术情况良好,手术时间39~221 min,术中出血量10~50 m L,术中取出胆道结石2~5枚,直径2~15 mm;术后2~3 d拔除腹腔引流管,术后住院时间4~6 d;全组术后胆漏1例（1/49,2.04%）,经腹腔引流3 d后愈合,术后6 d出院。结论 LC＋LTCBDE术式治疗胆囊结石合并胆总管结石安全、可靠,值得临床推广应用。展开更多
随着腹腔镜技术日益成熟,腹腔镜下胆总管切开取石术(laparoscopic choledochotomy for common bile duct exploration,LCCBDE)治疗胆总管结石也已广泛运用,其能有效避免开腹手术对患者机体造成的较大伤害。但LCCBDE术后需留置T管,易造...随着腹腔镜技术日益成熟,腹腔镜下胆总管切开取石术(laparoscopic choledochotomy for common bile duct exploration,LCCBDE)治疗胆总管结石也已广泛运用,其能有效避免开腹手术对患者机体造成的较大伤害。但LCCBDE术后需留置T管,易造成患者生活质量显著下降。腹腔镜经胆囊管胆总管取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)可显著避免上述缺点,但是因为该技术操作困难,国内尚未普遍开展。本文通过介绍该技术的历史、优势、适应证、禁忌证,与LCCBDE进行比较,以及当前发展现状,从而使读者对该技术获得充分了解。展开更多
目的:探讨经胆囊管汇入部切开胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效及对患者血清淀粉酶(AMS)、皮质醇(Cor)水平的影响。方法:选取2017年2月至2...目的:探讨经胆囊管汇入部切开胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效及对患者血清淀粉酶(AMS)、皮质醇(Cor)水平的影响。方法:选取2017年2月至2018年4月邢台医学高等专科学校第二附属医院收治的胆囊结石合并胆总管结石患者160例,使用随机数字表法分为观察组和对照组,每组80例。对照组患者采用LTCBDE术治疗,观察组患者在LTCBDE术后联合间苯三酚治疗。观察两组患者的围术期指标水平,治疗前后血清AMS、Cor、肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)]及炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)]水平,比较两组患者并发症发生情况和生活质量评分(quality of life score,QOL)的差异。结果:两组患者手术时间和术中出血量的差异均无统计学意义(P>0.05);观察组患者术后排气时间、术后住院时间明显短于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者血清AMS水平较治疗前明显升高,Cor水平较治疗前明显降低,且观察组患者AMS、Cor水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TBIL、ALT及AST水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TNF-α、IL-6及IL-8水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。两组患者胆管狭窄、切口感染、残留结石及胆瘘的发生率的差异均无统计学意义(P>0.05)。治疗后,两组患者QOL评分较治疗前明显升高,且观察组患者明显高于对照组,差异均有统计学意义(P<0.05)。结论:LTCBDE术后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效显著,可明显改善患者血清AMS、Cor水平,降低炎症因子水平,安全性较好。展开更多
本文报告了一例罕见的胆总管结石合并结肠癌的病例,旨在提高临床医生对该疾病组合的认识及诊断能力。本例报告强调了胆总管结石与结肠癌共存的可能性,尽管这种情况较为罕见,但临床医生在处理胆总管结石时,应警惕结肠癌等潜在合并症的存...本文报告了一例罕见的胆总管结石合并结肠癌的病例,旨在提高临床医生对该疾病组合的认识及诊断能力。本例报告强调了胆总管结石与结肠癌共存的可能性,尽管这种情况较为罕见,但临床医生在处理胆总管结石时,应警惕结肠癌等潜在合并症的存在。对于长期存在胆道症状、体重下降、贫血等不典型表现的患者,应进行全面系统的检查,以免漏诊或误诊。通过本例报告的分享,我们希望能够为临床医生在处理类似病例时提供参考和借鉴,提高对该疾病组合的诊断和治疗水平。This paper reports a rare case of concurrent choledocholithiasis and colon cancer, aiming to enhance clinicians’ understanding and diagnostic capabilities regarding this disease combination. This case report underscores the possibility of coexisting choledocholithiasis and colon cancer, which, though infrequent, necessitates vigilance among clinicians treating choledocholithiasis for potential comorbidities such as colon cancer. For patients with persistent biliary symptoms, weight loss, anemia, and other atypical presentations, comprehensive and systematic examinations are crucial to avoid missed or misdiagnoses. By sharing this case report, we hope to provide clinicians with a reference and insights when managing similar cases, thereby improving the diagnosis and treatment of this disease combination.展开更多
To the Editor:The global population is aging rapidly,and acute obstructive suppurative cholangitis(AOSC)has emerged as a common cause of acute abdominal disease in elderly people.Traditional open surgery faces growing...To the Editor:The global population is aging rapidly,and acute obstructive suppurative cholangitis(AOSC)has emerged as a common cause of acute abdominal disease in elderly people.Traditional open surgery faces growing challenges,and endoscopic retrograde cholangiopancreatography(ERCP)is currently the dominant treatment for AOSC in elderly patients.Even though laparoscopic transcystic common bile duct exploration(LTCBDE)for AOSC patients presents encouraging prospects,the surgical risks involved and the lower success rate remain substantial.Our team recently successfully treated an AOSC patient with LTCBDE who was as old as 90 years.The goal is to assess the potential of LTCBDE to challenge the current dominance of ERCP,to build consensus,and ultimately to benefit the broader population of elderly AOSC patients.展开更多
To the Editor:With the development of minimally invasive surgical technology,laparoscopic transcystic common bile duct exploration plus laparoscopic cholecystectomy(LTCBDE+LC)has become the first choice of treatment f...To the Editor:With the development of minimally invasive surgical technology,laparoscopic transcystic common bile duct exploration plus laparoscopic cholecystectomy(LTCBDE+LC)has become the first choice of treatment for cholecystolithiasis combined with biliary calculi.In addition,there is little prospective research.We compared 150 patients who underwent LTCBDE+LC with 150 patients who underwent laparoscopic transductal common bile duct exploration(LTDBDE)+LC.All patients and participants were informed of the study and voluntarily provided informed consent.展开更多
文摘目的分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)分别联合腹腔镜经胆囊管胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)与内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗胆囊结石合并胆总管结石的临床疗效。方法回顾性分析2016年7月至2021年7月上海市徐汇区中心医院收治的胆总管结石合并胆囊结石病人的临床治疗,采用倾向性评分匹配法将符合入组标准的LTCBDE+LC组病人与同期行ERCP+LC组病人进行匹配,每组纳入30例,比较两组间围手术期并发症、手术时间、检验指标及随访结石复发情况。结果两组病人均无围手术期死亡;同期ERCP+LC组发生1例术后高淀粉酶血症,经保守治疗后好转,术后并发症差异无统计学意义(P>0.05);LTCBDE+LC组与ERCP+LC组比较,所用手术时间[(95.40±21.40)min比(94.01±20.37)min]差异无统计学意义(P>0.05);术后第1天总胆红素[(29.20±4.15)μmol/L比(30.25±3.91)μmol/L]、直接胆红素[(10.55±3.56)μmol/L比(11.40±4.41)μmol/L]、丙氨酸转氨酶[(27.95±5.92)U/L比(28.55±5.71)U/L]差异均无统计学意义(均P>0.05);术后3个月复查磁共振胰胆管造影、超声检查均无结石复发、残留及胆管狭窄。结论LTCBDE+LC与ERCP+LC治疗胆囊结石合并胆总管结石均安全可靠;术前严格选择适应证,LTCBDE+LC在治疗方面是更值得推广的比较好的方法。
文摘随着腹腔镜技术日益成熟,腹腔镜下胆总管切开取石术(laparoscopic choledochotomy for common bile duct exploration,LCCBDE)治疗胆总管结石也已广泛运用,其能有效避免开腹手术对患者机体造成的较大伤害。但LCCBDE术后需留置T管,易造成患者生活质量显著下降。腹腔镜经胆囊管胆总管取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)可显著避免上述缺点,但是因为该技术操作困难,国内尚未普遍开展。本文通过介绍该技术的历史、优势、适应证、禁忌证,与LCCBDE进行比较,以及当前发展现状,从而使读者对该技术获得充分了解。
文摘目的:探讨经胆囊管汇入部切开胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效及对患者血清淀粉酶(AMS)、皮质醇(Cor)水平的影响。方法:选取2017年2月至2018年4月邢台医学高等专科学校第二附属医院收治的胆囊结石合并胆总管结石患者160例,使用随机数字表法分为观察组和对照组,每组80例。对照组患者采用LTCBDE术治疗,观察组患者在LTCBDE术后联合间苯三酚治疗。观察两组患者的围术期指标水平,治疗前后血清AMS、Cor、肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)]及炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和白细胞介素8(IL-8)]水平,比较两组患者并发症发生情况和生活质量评分(quality of life score,QOL)的差异。结果:两组患者手术时间和术中出血量的差异均无统计学意义(P>0.05);观察组患者术后排气时间、术后住院时间明显短于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者血清AMS水平较治疗前明显升高,Cor水平较治疗前明显降低,且观察组患者AMS、Cor水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TBIL、ALT及AST水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者TNF-α、IL-6及IL-8水平均较治疗前明显降低,且观察组患者明显低于对照组,差异均有统计学意义(P<0.05)。两组患者胆管狭窄、切口感染、残留结石及胆瘘的发生率的差异均无统计学意义(P>0.05)。治疗后,两组患者QOL评分较治疗前明显升高,且观察组患者明显高于对照组,差异均有统计学意义(P<0.05)。结论:LTCBDE术后应用间苯三酚治疗胆囊结石合并胆总管结石的疗效显著,可明显改善患者血清AMS、Cor水平,降低炎症因子水平,安全性较好。
文摘本文报告了一例罕见的胆总管结石合并结肠癌的病例,旨在提高临床医生对该疾病组合的认识及诊断能力。本例报告强调了胆总管结石与结肠癌共存的可能性,尽管这种情况较为罕见,但临床医生在处理胆总管结石时,应警惕结肠癌等潜在合并症的存在。对于长期存在胆道症状、体重下降、贫血等不典型表现的患者,应进行全面系统的检查,以免漏诊或误诊。通过本例报告的分享,我们希望能够为临床医生在处理类似病例时提供参考和借鉴,提高对该疾病组合的诊断和治疗水平。This paper reports a rare case of concurrent choledocholithiasis and colon cancer, aiming to enhance clinicians’ understanding and diagnostic capabilities regarding this disease combination. This case report underscores the possibility of coexisting choledocholithiasis and colon cancer, which, though infrequent, necessitates vigilance among clinicians treating choledocholithiasis for potential comorbidities such as colon cancer. For patients with persistent biliary symptoms, weight loss, anemia, and other atypical presentations, comprehensive and systematic examinations are crucial to avoid missed or misdiagnoses. By sharing this case report, we hope to provide clinicians with a reference and insights when managing similar cases, thereby improving the diagnosis and treatment of this disease combination.
基金supported by grants from Beijing Municipal Science & Technology Commission(No.Z171100000417056)the Key Support Project of Guo Zhong Health Care of China General Technology Group(Nos.GZKJ-KJXX-QTHT-20230626 and 20240429).
文摘To the Editor:The global population is aging rapidly,and acute obstructive suppurative cholangitis(AOSC)has emerged as a common cause of acute abdominal disease in elderly people.Traditional open surgery faces growing challenges,and endoscopic retrograde cholangiopancreatography(ERCP)is currently the dominant treatment for AOSC in elderly patients.Even though laparoscopic transcystic common bile duct exploration(LTCBDE)for AOSC patients presents encouraging prospects,the surgical risks involved and the lower success rate remain substantial.Our team recently successfully treated an AOSC patient with LTCBDE who was as old as 90 years.The goal is to assess the potential of LTCBDE to challenge the current dominance of ERCP,to build consensus,and ultimately to benefit the broader population of elderly AOSC patients.
文摘To the Editor:With the development of minimally invasive surgical technology,laparoscopic transcystic common bile duct exploration plus laparoscopic cholecystectomy(LTCBDE+LC)has become the first choice of treatment for cholecystolithiasis combined with biliary calculi.In addition,there is little prospective research.We compared 150 patients who underwent LTCBDE+LC with 150 patients who underwent laparoscopic transductal common bile duct exploration(LTDBDE)+LC.All patients and participants were informed of the study and voluntarily provided informed consent.
