目的:探讨十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石患者的临床疗效。方法:选取2011年1月—2015年6月收治的老年胆囊结石合并肝外胆管结石患者120例,依据手术方式的选择分为对照组与观察组,每组各60例。对照组采用传统开...目的:探讨十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石患者的临床疗效。方法:选取2011年1月—2015年6月收治的老年胆囊结石合并肝外胆管结石患者120例,依据手术方式的选择分为对照组与观察组,每组各60例。对照组采用传统开腹胆囊切除、胆总管切开取石及T管引流术治疗,观察组采用十二指肠镜切开取石联合腹腔镜胆囊切除术的微创手术治疗,比较两组患者的相关临床指标及疗效。结果:与对照组比较,观察组术中出血量(60.74 m L vs.98.42 m L)、住院时间(10.8 d vs.12.3 d)明显减少,但手术时间(3.12 h vs.2.06 h)、住院费用(18 047.53元vs.12 054.88元)明显增加(均P<0.05);疼痛评分(3.8 vs.4.9)明显降低、肠道功能恢复时间(1.8 d vs.3.5 d)与腹腔引流时间(1.7 d vs.3.3 d)明显减少,胃肠道不良反应发生率(10.0%vs.25.0%)明显降低(均P<0.05);总并发症的发生率(20.0%vs.41.7%)明显降低,但急性胰腺炎(16.7%vs.3.3%)的发生率增高(均P<0.05)。术后随访,观察组反流性胆管炎发生率(13.3%vs.1.7%)高于对照组,但术后满意率(93.5%vs.78.2%)、恢复正常生活时间(25.8 d vs.48.7 d)均优于对照组,观察组与对照组结石复发率(3.3%vs.6.7%)差异无统计学意义(P>0.05)。结论:十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石的中具有恢复快、并发症低、住院时间短及远期疗效好的优点,充分体现了微创手术的优势。展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease.Most commonly,ERCPs are performed for choledocholithiasis wi...Endoscopic retrograde cholangiopancreatography(ERCP)has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease.Most commonly,ERCPs are performed for choledocholithiasis with or without cholangitis,but improvements in technology and technique have allowed for management of pancreatic duct stones,benign and malignant strictures,and bile and pancreatic leaks.As an example of necessity driving innovation,the new disposable duodenoscopes have been introduced into practice.With the advantage of eliminating transmissible infections,they represent a paradigm shift in quality improvement within ERCP.With procedures becoming more complicated,the necessity for anesthesia involvement and safety of propofol use and general anesthesia has become better defined.The improvements in endoscopic ultrasound(EUS)have allowed for direct bile duct access and EUS facilitated bile duct access for ERCP.In patients with surgically altered anatomy,selective cannulation can be performed with overtube-assisted enteroscopy,laparoscopic surgery assistance,or the EUS-directed transgastric ERCP.Cholangioscopy and pancreatoscopy use has become ubiquitous with defined indications for large bile duct stones,indeterminate strictures,and hepatobiliary and pancreatic neoplasia.This review summarizes the recent advances in infection prevention,quality improvement,pancreaticobiliary access,and management of hepatobiliary and pancreatic diseases.Where appropriate,future research directions are included in each section.展开更多
文摘目的:探讨十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石患者的临床疗效。方法:选取2011年1月—2015年6月收治的老年胆囊结石合并肝外胆管结石患者120例,依据手术方式的选择分为对照组与观察组,每组各60例。对照组采用传统开腹胆囊切除、胆总管切开取石及T管引流术治疗,观察组采用十二指肠镜切开取石联合腹腔镜胆囊切除术的微创手术治疗,比较两组患者的相关临床指标及疗效。结果:与对照组比较,观察组术中出血量(60.74 m L vs.98.42 m L)、住院时间(10.8 d vs.12.3 d)明显减少,但手术时间(3.12 h vs.2.06 h)、住院费用(18 047.53元vs.12 054.88元)明显增加(均P<0.05);疼痛评分(3.8 vs.4.9)明显降低、肠道功能恢复时间(1.8 d vs.3.5 d)与腹腔引流时间(1.7 d vs.3.3 d)明显减少,胃肠道不良反应发生率(10.0%vs.25.0%)明显降低(均P<0.05);总并发症的发生率(20.0%vs.41.7%)明显降低,但急性胰腺炎(16.7%vs.3.3%)的发生率增高(均P<0.05)。术后随访,观察组反流性胆管炎发生率(13.3%vs.1.7%)高于对照组,但术后满意率(93.5%vs.78.2%)、恢复正常生活时间(25.8 d vs.48.7 d)均优于对照组,观察组与对照组结石复发率(3.3%vs.6.7%)差异无统计学意义(P>0.05)。结论:十二指肠镜联合腹腔镜治疗老年胆囊结石合并肝外胆管结石的中具有恢复快、并发症低、住院时间短及远期疗效好的优点,充分体现了微创手术的优势。
文摘Endoscopic retrograde cholangiopancreatography(ERCP)has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease.Most commonly,ERCPs are performed for choledocholithiasis with or without cholangitis,but improvements in technology and technique have allowed for management of pancreatic duct stones,benign and malignant strictures,and bile and pancreatic leaks.As an example of necessity driving innovation,the new disposable duodenoscopes have been introduced into practice.With the advantage of eliminating transmissible infections,they represent a paradigm shift in quality improvement within ERCP.With procedures becoming more complicated,the necessity for anesthesia involvement and safety of propofol use and general anesthesia has become better defined.The improvements in endoscopic ultrasound(EUS)have allowed for direct bile duct access and EUS facilitated bile duct access for ERCP.In patients with surgically altered anatomy,selective cannulation can be performed with overtube-assisted enteroscopy,laparoscopic surgery assistance,or the EUS-directed transgastric ERCP.Cholangioscopy and pancreatoscopy use has become ubiquitous with defined indications for large bile duct stones,indeterminate strictures,and hepatobiliary and pancreatic neoplasia.This review summarizes the recent advances in infection prevention,quality improvement,pancreaticobiliary access,and management of hepatobiliary and pancreatic diseases.Where appropriate,future research directions are included in each section.
