双镜联合胆总管探查切开取石术治疗胆石症引起的急性胆源性胰腺炎68例疗效观察

Acute Biliary Pancreatitis 68 Cases Induced by Treating Cholelithiasis Treated with Bi-microscope Combined with Choledoch Probe Incision for LCDE

[目的]探讨腹腔镜联合胆道镜胆总管探查切开取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆石症引起的急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的临床效果。[方法]选择我院行LCBDE的68例胆石症引起的ABP患者为实验组,同期行开腹胆总管切开取石T管引流术(open choledocholithotomy T-tube drainage,OCTD)的87例胆石症引起的ABP患者为对照组。比较两组手术时间、术后恢复情况、取石结果及并发症情况。[结果]实验组68例均成功完成LCBDE,无中转开腹;取净胆管内结石61例,T管拔除为术后4周;残余结石7例于术后6周经T管窦道胆道镜再次取残余结石。对照组87例行OCTD成功79例,失败8例6周后经胆道镜取尽石;OCTD术中取净结石者71例,T管拔除为术后6周,未取尽者于术后6周经T管窦道胆道镜再次取尽残余结石。两组在术后恢复、并发症发生方面,实验组优于对照组(P<0.05,P<0.01)。[结论]LCBDE一期治疗胆石症引起的ABP安全可行,创伤小,恢复快,疗效好。

[Objective]To discuss the clinical effect of laparoscopic common bile duct exploration（LCBDE）on acute biliary pancreatitis（ABP）induced by treating cholelithiasis. [Method] Select 68 cases of ABP having LCBDE induced with cholelithiasis as experimental group, and other 87 cases of open choledocholitho tomy T-tube drainage（OCTD） as control group;both had routine treatment before operation. Compare their operational time, bed time, post-operation gastro-intestinal recovery time, drainage tube removing time, time of leaving hospital, results of calculus removal and complications. [Result] In experimental group, the operational time was 115-205min,（143.62 ＆#177;28.73）min in average, both successful y finishing LCBDE, without conversion to open laparotomy. Calculus removal result： 61 cases were al removed the calculus in the bile duct, the T tube was removed 4w after operation; the remained calculus in 7 cases were removed completely after 6w through T tube sinus tract choledochoscope. In the control groups： the operation time was 120-150min,（135.07 ＆#177;15.01）min in average;79 cases had successful OCTD, other 8 cases ended the operation in advance over constitution and much bleeding in operation, and finished the calculus removal after 6w. On post-operational complication, the experimental group had no severe complications, however, there’re 10 cases with complications in control group; in fol owing up, the experimental group had no complications, but there’re 3 cases with complications in control one. Both groups had no statistical meaning for difference on operational time; on bed time, post-operational gastro-intestinal recovery time, drainage removal time, time leaving hospital and complications, the experimental group was markedly better than control one.[Conclusion] LCBDE phase-1 treating ABP induced by cholelithiasis is safe and available, with little trauma, quick recovery and good cure effect.