摘要
目的探讨内镜下逆行胰胆管造影术(ERCP)联合内镜下十二指肠乳头括约肌切开术(EST)治疗胆囊结石合并胆总管结石的临床疗效及安全性。方法选取胆囊结石合并胆总管结石患者137例,均行ERCP+EST治疗。观察患者手术情况、术后残余结石情况和并发症发生情况;记录手术时间、术中出血量、术后禁食时间、排便时间和住院时间。结果 133例患者顺利完成ERCP+EST手术,手术成功率97.08%(133/137)。其中120例术后1周内行三孔法LC,30例ERCP术后出现血淀粉酶升高,5例并发急性胰腺炎,2例Oddi括约肌出血。患者平均手术时间、术中出血量、术后禁食时间、排便时间和住院时间分别为(50.78±16.45)min、(17.85±6.20)m L、(2.21±0.84)d、(1.82±0.80)d及(3.87±1.60)d。一期结石清除率为97.74%(130/133),二期为100%(3/3)。门诊随访6个月,未发现结石复发和胆道狭窄。结论 ERCP+EST+LC治疗胆囊结石合并胆总管结石具有创伤小、效果好、恢复快、并发症少、残余结石少等优点,是最佳微创治疗方案,值得临床广泛应用。
Objective To investigate the clinical effects and safety of endoscopic retrograde cholangiopancreatography（ ERCP） combined with endoscopic sphincterotomy（ EST） in treatment of cholecystolithiasis and choledocholith. Methods A total of 137 patients with cholecystolithiasis and choledocholith underwent ERCP ＋ EST ＋ laparoscopic cholecystectomy（ LC）. The operation condition,residual stones after operation and complication were observed,and surgical duration,intraoperative blood loss,postoperative fasting time,defecating time and length of stay were recorded. Results A total of 133 patients（ 97. 08%） completed the ERCP ＋ EST successfully,in which 120 cases underwent three- port- looping LC,30 cases with increased blood amylase,5 cases with acute pancreatitis and 2 cases with sphincter of Oddi bleeding after surgery. The mean surgical duration,intraoperative blood loss postoperative fasting time,defecating time and length of stay were（ 50. 78 ± 16. 45） min,（ 17. 85 ± 6. 20） m L,（ 2. 21 ± 0. 84） d,（ 1. 82 ± 0. 80） d and（ 3. 87 ± 1. 60） d,respectively. First and second time stone clearance rate were 97. 74%（ 130 /133） and 100%（ 3 /3）,respectively. There was no calculus recurrence or biliary Stricture in 6 month follow- up. Conclusion ERCP ＋ EST ＋LC,with minimal trauma,rapid recovery,less complication and residual stones,is an optimal mini-invasive operation for cholecystolithiasis and choledocholith.
出处
《实用临床医药杂志》
CAS
2015年第23期72-74,共3页
Journal of Clinical Medicine in Practice
基金
中国高校医学期刊临床专项资金(11523179)
