摘要
目的评价十二指肠镜联合腹腔镜治疗胆囊结石和胆总管结石的临床效果,与传统开腹胆囊切除、胆总管切开取石比较分析。方法选择60例胆囊结石并胆总管结石患者,按随机数字表法分为双镜微创组和开腹组,其中30例双镜微创组先行内镜胰胆管造影(ERCP)+十二指肠乳头Oddis括约肌切开术(EST)+胆总管取石术,再行腹腔镜胆囊切除术(LC术)。另外30例行传统开腹胆囊切除+胆总管切开取石术。将两组的手术时间、平均住院时间、并发症发生率进行比较分析。结果双镜微创组26例患者ERCP+EST+胆总管取石术成功,胆总管结石全部取出,术后留置鼻胆管引流;4例由于结石过大未取出,留置胆管支架。25例1周内行三孔法LC术。10例并发胰腺炎,2例患者年龄较大,合并高血压病等基础病,治疗后2周行LC术。双镜微创组创伤小,出血量少,恢复快,但容易并发胰腺炎。传统开腹组创伤大,出血量较多,12例结石未完全取出,容易并发切口感染,恢复时间长。结论 ERCP联合LC术用于治疗胆囊、胆总管结石具有效果好、创伤小、术后并发症少、恢复快等优点,临床疗效满意。
Objective To evaluate the clinical effect of duodenoscopy combined with laparoscopy in the treatment of gallstone and choledocholithiasis,and to compare with traditional cholecystectomy and choledocholithotomy. Methods Sixty patients of gallstone and choledocholithiasis admitted were randomized into minimally invasive double endoscopic group and laparotomy group. The 30 patients of minimally invasive double endoscopic group were firstly given endoscopic retrograde cholangiopancreatography（ ERCP） ＋ endoscopic sphincterotomy（ EST） ＋ choledocholithotomy,then given laparoscopic cholecystectomy（ LC）. The other 30 patients underwent traditional cholecystectomy and choledocholithotomy. The operation time,the average hospital stay and complications were comparatively analyzed between the two groups. Results In 26 patients of minimally invasive double endoscopic group,the choledocholithiasis were all removed,and the nasal biliary drainage was given after surgery. Another four cases failed because of too large stones,and bile duct stent were retained. Twenty-five patients underwent LC operation with three holes within 1 week. There were 10 patients complicated with pancreatitis,and two older patients complicated with basic diseases such as hypertension. They received LC treatment after 2 weeks. In minimally invasive double endoscopic group,there were advantages of minor trauma,less bleeding and fast recovery,but patients were likely to be complicated with pancreatitis. In laparotomy group,there were great trauma,more bleeding,vulnerability to complication of incision infection,longer recovery time,and 12 patients failed to remove stones completely. Conclusions The ERCP combined with LC operation for the treatment of cholecystolithiasis and choledocholithiasis have the advantages of better effect,less trauma,fewer complications and fast recovery,which achieved satisfactory clinical effect.
出处
《安徽医药》
CAS
2016年第10期1902-1904,共3页
Anhui Medical and Pharmaceutical Journal
关键词
十二指肠镜
腹腔镜
胆囊结石
胆总管结石
经内镜逆行胰胆管造影
Duodenoscopy
Laparoscopy
Gallstone
Choledocholithiasis
Endoscopic retrograde cholangiopancreatography
