摘要
目的探讨经内镜逆行胰胆管造影术(ERCP)与腹腔镜胆道手术在肝内外胆管结石治疗中的疗效。方法对110例肝内胆管结石位于Ⅰ和Ⅱ级肝管与378例单纯胆总管结石患者行ERCP+内镜下十二指肠乳头括约肌切开术(EST)+经内镜鼻胆管引流术(ENBD),或腹腔镜胆道探查取石术(LBDEL)联合激光碎石术,术中胆管一期缝合或放置T管,比较两种术式的围手术期并发症及术后恢复情况。结果 110例肝内胆管结石患者结石残余率为31.82%,其中ERCP组(51.06%)残余结石率高于LBDEL组(17.46%)(P<0.05),术后恢复LBDEL组优于ERCP组。378例单纯胆总管结石患者结石残余率为8.20%,其中ERCP组(3.68%)残余结石率低于LBDEL组(11.63%)(P<0.05);术后恢复情况两组差异无统计学意义(P>0.05)。术后并发症中LBDEL组胆漏与肺部感染发生率高于ERCP组;腹腔感染、急性胰腺炎、消化道出血及消化道穿孔方面ERCP组发生率高于LBDEL组。单纯胆总管结石患者ERCP治疗时出现2例消化道穿孔导致死亡。结论 LBDEL和ERCP治疗胆总管结石具有相同的临床疗效,但在肝内胆管结石治疗中ERCP优势不明显,术后并发症发生率高。LBDEL治疗肝内外胆管结石疗效显著,可保持Oddi括约肌的完整性,该项技术易于普及到基层医院,令广大患者受益。
Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic bile duct exploration lithotomy(LBDEL)in treatment of intra/extra-hepatic ductstones.Methods There were110patients whose intrahepatic stones located inⅠ,Ⅱhepatic duct and378patientswhose stones only located in the common bile duct.These patients respectively underwent LBDE combined withcholedochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy(EST)and endoscopicnasobiliary drainage(ENBD)to remove the stones.Common bile ducts were performed primary suture or T tubeplacement in the LBDEL cases.The evaluation was carried out for perioperative complications and postoperativerecovery of the surgical methods.Results The residual stone rate was31.82%in110cases.The rate was higher inERCP group(51.06%)than that in LBDEL group(17.46%)(P<0.05).Postoperative recovery was better in LBDEL group than that in ERCP group.The residual stone rate was8.20%in378cases.The rate was lower in ERCP group(3.68%)than that in LBDEL group(11.63%)(P<0.05).Between the two groups,there had no statistical significancein postoperative recovery.The incidences of bile leakage and pulmonary infection were higher in LBDEL groupthan in ERCP group.The incidences of abdominal cavity infection,acute pancreatitis,digestive tract perforation andgastrointestinal bleeding were higher in ERCP group than that in LBDEL group.2of the378patients occurred deathwere happened digestive tract perforation which were induced during ERCP procedure.Conclusion LBDEL andERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones.However,ERCP hasno large advantages in the treatment of hepatolithiasis,and shows higher complication rates.LBDEL has a significantcurative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter.Thistechnology is easy to spread to the basic-level hospital to benefit the majority of patients.
作者
谷化剑
郭宇廷
韩民
喻超
陈自力
潘耀振
孙诚谊
Hua-jian Gu;Yu-ting Guo;Min Han;Chao Yu;Zi-li Chen;Yao-zhen Pan;Cheng-yi Sun(Department of Hepatobiliary Surgery, the Affiliated Hospital of Guizhou Medical College,Guiyang, Guizhou 550025, China)
出处
《中国内镜杂志》
北大核心
2017年第8期32-37,共6页
China Journal of Endoscopy
