摘要
目的探讨腹腔镜联合胆道镜经胆囊管胆总管探查术(LCTCBDE)治疗继发性胆总管结石的应用效果。方法回顾性分析32例行LCTCBDE治疗的继发性胆总管结石患者的临床资料,记录患者手术时间、术中出血量、术后住院时间、相关并发症(胆漏、一过性胰腺炎等)及复发情况。结果 32例患者中,28例完成LCTCBDE,4例经胆囊管探查失败。LCTCBDE手术时间为(128. 3±38. 1) min,术中出血量(45. 0±8. 5) ml,取出胆总管结石1～8颗,结石直径为2～8 mm,术后住院时间(4. 6±1. 2) d。术后发生胆漏2例,一过性胰腺炎1例,均经对症治疗后痊愈。所有患者术后1个月内胆红素及转氨酶等肝功能指标逐渐降至正常,CT或MRI检查提示均无结石残留。术后随访4个月至3年,患者均无结石复发。结论 LCTCBDE治疗继发性胆总管结石疗效确切,安全性高,但需严格把握适应证,提高手术技巧。
Objective To explore the application efficacy of laparoscopic-choledochoscopic transcystic common bile duct exploration( LCTCBDE) for secondary choledocholithiasis. Methods The clinical data of 32 patients with secondary choledocholithiasis undergoing LCTCBDE were retrospectively analyzed. The operation duration,intraoperative blood loss,postoperative hospital stay,incidence of related complications( bile leakage,transient pancreatitis,etc.),and recurrence of the patients were recorded. Results Of the 32 patients,28 completed LCTCBDE,and 4 failed in transcystic duct exploration. The operation duration of LCTCBDE was 128. 3 ± 38. 1 minutes,the blood loss amounted to 45. 0 ± 8. 5 ml,1 to 8 common bile duct stones were removed,with a stone diameter of 2 to 8 mm,and the postoperative hospital stay was 4. 6 ± 1. 2 days. Postoperative bile leakage occurred in 2 cases and transient pancreatitis occurred in 1 case,and they all recovered after symptomatic treatment. Bilirubin,aminotransferase and other indices of liver function gradually decreased to the normal in all patients within 1 month after operation,CT or MRI revealed that no residual stones were observed. The postoperative follow-up lasted for4 months to 3 years,and no recurrence of choledocholithiasis occurred. Conclusion LCTCBDE has distinct efficacy for secondary choledocholithiasis with a favorable safety,but it is necessary to strictly grasp the indications and improve the surgical skills.
作者
潘孟
李敏朋
俞渊
许斌
潘壮
常明
PAN Meng;LI Min-peng;YU Yuan;XU Bin;PAN Zhuang;CHANG Ming(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Nanning 530023,China)
出处
《广西医学》
CAS
2018年第23期2757-2759,共3页
Guangxi Medical Journal
基金
广西自然科学基金(2017GXNSFAA198120)
广西医药卫生科研课题(Z2015473)
关键词
继发性胆总管结石
腹腔镜
胆道镜
胆囊管途径
胆道探查
Secondary choledocholithiasis
Laparoscopy
Choledochoscope
Cystic duct approach
Biliary tract exploration
