目的通过比较腹腔镜下胆总管探查术(LCBDE)与内镜下逆行胰胆管造影(ERCP)+括约肌切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效,提供此类型胆总管结石的临床治疗思路。方法回顾性分析本院2017年1—12月80例胆囊切除术后胆总管结石...目的通过比较腹腔镜下胆总管探查术(LCBDE)与内镜下逆行胰胆管造影(ERCP)+括约肌切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效,提供此类型胆总管结石的临床治疗思路。方法回顾性分析本院2017年1—12月80例胆囊切除术后胆总管结石患者临床资料,其中采取腹腔镜下胆总管探查术(LCBDE)患者40例,ERCP/EST取石术患者40例,比较两种手术方式治疗胆总管结石的取石成功率,手术时间、术中出血、术后淀粉酶、平均住院时间、术后并发症等指标。结果两组患者性别、年龄、合并基础疾病等术前相关指标无统计学差异(P>0.05),具有可比性。LCBDE组与ERCP/EST组患者取石成功率(95.0%VS 85.0%),术中出血[(32.25±6.40) ml VS(28.75±5.03) ml]等比较无统计学意义(P>0.05); ERCP/EST组在手术时间[(52.75±16.28) min VS (145±48.18) min]及平均住院时间[(8.65±2.37) d VS(12.68±3.37) d]上要优于LCBDE组(P<0.05),但ERCP/EST组术后淀粉酶[(128.15±85.10) U/L VS(263.83±142.96) U/L]要高于LCBDE组,且手术总体并发症要高于LCBDE组(42.5%VS 10.0%,P<0.05)。结论两组手术方式均能够有效治疗胆总管结石,选择哪种手术方式需要根据患者自身具体情况而定。展开更多
目的探讨胆囊结石合并胆总管结石的外科微创治疗方式的选择,对比研究内镜下乳头括约肌切开术+腹腔镜胆囊切除(endoscopic sphincterotomy+laparoscopic cholecystectomy,EST+LC)和腹腔镜下胆总管探查(laparoscopic explorationof common...目的探讨胆囊结石合并胆总管结石的外科微创治疗方式的选择,对比研究内镜下乳头括约肌切开术+腹腔镜胆囊切除(endoscopic sphincterotomy+laparoscopic cholecystectomy,EST+LC)和腹腔镜下胆总管探查(laparoscopic explorationof common bile duct/laparoscopic transcystic exploration of common bile duct,LCBDE/LTCBDE)。方法回顾分析2009年8月～2011年9月手术治疗胆囊结石合并胆总管结石56例的临床资料,EST+LC组26例,LCBDE/LTCBDE组30例,2组年龄、性别、体重指数、丙氨酸转氨酶、总胆红素、胆总管直径和ASA评分差异无显著性。对比2种微创治疗方式的住院时间、住院费用和治疗效果。结果 2组住院时间差异无显著性[(9.0±3.5)d vs.(10.1±3.4)d,t=-1.191,P=0.256]。EST+LC组住院费用高于LCBDE/LTCBDE组[(20 017.5±4748.8)元vs.(16 249.5±3366.1)元,t=3.459,P=0.001]。2组并发症和中转开腹的发生率差异无显著性[15.4%(4/26)vs.13.3%(4/30),χ2=0.000,P=1.000]。结论 EST+LC和LCBDE/LTCBDE是胆囊结石合并胆总管结石有效、安全的治疗方式,LCBDE/LTCBDE住院费用明显降低,两者之间并发症并无明显差异。展开更多
Surgical fraternity has not yet arrived at any consensus for adequate treatment of choledocholithiasis. Sequential treatment in the form of pre-operative endoscopic retrograde cholangio-pancreatography followed by lap...Surgical fraternity has not yet arrived at any consensus for adequate treatment of choledocholithiasis. Sequential treatment in the form of pre-operative endoscopic retrograde cholangio-pancreatography followed by laparoscopic cholecystectomy(LC) is considered as optimal treatment till date. With refinements in technique and expertise in field of minimal access surgery, many centres in the world have started offering one stage management of choledocholithiasis by LC with laparoscopic common bile duct exploration(LCBDE). Various modalities have been tried for entering into concurrent common bile duct(CBD) [transcystic(TC) vs transcholedochal(TD)], for confirming stone clearance(intraoperative cholangiogram vs choledochoscopy), and for closure of choledochotomy(T-tube vs biliary stent vs primary closure) during LCBDE. Both TC and TD approaches are safe and effective. TD stone extraction is involved with an increased risk of bile leaks and requires more expertise in intra-corporeal suturing and choledochoscopy. Choice depends on number of stones, size of stone, diameter of cystic duct and CBD. This review article was undertaken to evaluate the role of LCBDE for the management of choledocholithiasis.展开更多
文摘目的通过比较腹腔镜下胆总管探查术(LCBDE)与内镜下逆行胰胆管造影(ERCP)+括约肌切开取石术(EST)治疗胆囊切除术后胆总管结石的疗效,提供此类型胆总管结石的临床治疗思路。方法回顾性分析本院2017年1—12月80例胆囊切除术后胆总管结石患者临床资料,其中采取腹腔镜下胆总管探查术(LCBDE)患者40例,ERCP/EST取石术患者40例,比较两种手术方式治疗胆总管结石的取石成功率,手术时间、术中出血、术后淀粉酶、平均住院时间、术后并发症等指标。结果两组患者性别、年龄、合并基础疾病等术前相关指标无统计学差异(P>0.05),具有可比性。LCBDE组与ERCP/EST组患者取石成功率(95.0%VS 85.0%),术中出血[(32.25±6.40) ml VS(28.75±5.03) ml]等比较无统计学意义(P>0.05); ERCP/EST组在手术时间[(52.75±16.28) min VS (145±48.18) min]及平均住院时间[(8.65±2.37) d VS(12.68±3.37) d]上要优于LCBDE组(P<0.05),但ERCP/EST组术后淀粉酶[(128.15±85.10) U/L VS(263.83±142.96) U/L]要高于LCBDE组,且手术总体并发症要高于LCBDE组(42.5%VS 10.0%,P<0.05)。结论两组手术方式均能够有效治疗胆总管结石,选择哪种手术方式需要根据患者自身具体情况而定。
文摘目的探讨胆囊结石合并胆总管结石的外科微创治疗方式的选择,对比研究内镜下乳头括约肌切开术+腹腔镜胆囊切除(endoscopic sphincterotomy+laparoscopic cholecystectomy,EST+LC)和腹腔镜下胆总管探查(laparoscopic explorationof common bile duct/laparoscopic transcystic exploration of common bile duct,LCBDE/LTCBDE)。方法回顾分析2009年8月～2011年9月手术治疗胆囊结石合并胆总管结石56例的临床资料,EST+LC组26例,LCBDE/LTCBDE组30例,2组年龄、性别、体重指数、丙氨酸转氨酶、总胆红素、胆总管直径和ASA评分差异无显著性。对比2种微创治疗方式的住院时间、住院费用和治疗效果。结果 2组住院时间差异无显著性[(9.0±3.5)d vs.(10.1±3.4)d,t=-1.191,P=0.256]。EST+LC组住院费用高于LCBDE/LTCBDE组[(20 017.5±4748.8)元vs.(16 249.5±3366.1)元,t=3.459,P=0.001]。2组并发症和中转开腹的发生率差异无显著性[15.4%(4/26)vs.13.3%(4/30),χ2=0.000,P=1.000]。结论 EST+LC和LCBDE/LTCBDE是胆囊结石合并胆总管结石有效、安全的治疗方式,LCBDE/LTCBDE住院费用明显降低,两者之间并发症并无明显差异。
文摘Surgical fraternity has not yet arrived at any consensus for adequate treatment of choledocholithiasis. Sequential treatment in the form of pre-operative endoscopic retrograde cholangio-pancreatography followed by laparoscopic cholecystectomy(LC) is considered as optimal treatment till date. With refinements in technique and expertise in field of minimal access surgery, many centres in the world have started offering one stage management of choledocholithiasis by LC with laparoscopic common bile duct exploration(LCBDE). Various modalities have been tried for entering into concurrent common bile duct(CBD) [transcystic(TC) vs transcholedochal(TD)], for confirming stone clearance(intraoperative cholangiogram vs choledochoscopy), and for closure of choledochotomy(T-tube vs biliary stent vs primary closure) during LCBDE. Both TC and TD approaches are safe and effective. TD stone extraction is involved with an increased risk of bile leaks and requires more expertise in intra-corporeal suturing and choledochoscopy. Choice depends on number of stones, size of stone, diameter of cystic duct and CBD. This review article was undertaken to evaluate the role of LCBDE for the management of choledocholithiasis.
