术中联合胆道镜应用在胰管结石治疗中的疗效观察

The Observation of Therapeutic Effect of the Treatment of Pancreatic Dust Tones in which Intraoperative Choledochoscopy was Used Jointly

目的探讨胆道镜取石及碎石在胰管结石手术中的应用价值。方法通过病例资料回顾性分析本院收治的胰管结石46例患者的临床资料,2例因合并胰头癌行胰十二指肠切除术(Whipple),1例行胰体尾部加脾切除术,1例行胰尾加脾切除、胰腺断端空肠吻合术(Pusetow),其中行胰管切开取石、疏通主胰管并联合胰肠Roux-en-Y吻合术,术中应用胆道镜取石及碎石治疗20例胰管结石患者(胆道镜联合手术组),并与期间仅行胰管切开取石、疏通主胰管并联合胰肠Roux-en-Y吻合术治疗10例胰管结石患者(常规手术组)以及仅行内镜下逆行性胰胆管造影(ERCP)联合体外震波碎石(ESWL)术治疗12例胰管结石患者(ERCP+ESWL组)在术中失血量、术后残石率、术后疼痛缓解率、腹泻缓解率、糖尿病缓解率方面进行比较。结果与常规手术组比较,胆道镜联合手术组及ERCP+ESWL组在术中失血量、术后残石率、术后疼痛缓解率方面差异有显著性(P<0.05);胆道镜联合手术组与ERCP+ESWL组比较,在术中失血量、术后残石率、术后疼痛缓解率、腹泻缓解率方面差异均有显著性(P<0.05),而在糖尿病缓解率方面,差异无显著性(P>0.05)。结论在胰管结石的治疗中,外科手术中联合应用胆道镜取石、碎石技术能显著减少结石残留率及术中出血量,并明显提高患者术后上腹部疼痛缓解率。

Objective To investigate the applied value of Choledochoscopy and electrohydraulic lithotripsy（ EHL） in the operation of pancreatolithiasis. Methods The clinical data of diagnosis and treatment for pancretic duct stone in 46 patients treated in the Second Affiliated Hospital of University of South China from January 2002 to April 2014 were retrospectively analyzed,two patients underwent pancreatic coduodenectomy（ Whipple） for being combined with pancreatic head carcinoma,one patient underwent resection of pancreatic tail and spleen and pancreatic stump jejunosomy（ Pusetow） 20 patients underwent the pancreatic duct lithotomy,dredging main pancreatic duct and pancreatic enteric anastomosis combined with Roux-en-Y,with intraoperative choledochscopy being used jointly（ Choledochoscopy combined with Operation group）.During the period of only with the pancreatic duct lithotomy,dredge main pancreatic duct and pancreatic enteric anastomosis combined with Roux-en-Y,and the data of these patients were originated in the data of 10 patients with pancreatolithiasis（ Routine group）,and the data of 12 patients who were treated by Endoscopic retrograde cholangiopan-Creatography（ ERCP） combined with extracorporeal shock wave lithotripsy（ ESWL）（ ERCP ＋ ESWL group） were compared. Results The intraoperative blood loss was more than that in the ERCP ＋ ESWL group[（ 120 ± 55. 9） m L vs（ 30 ± 15. 4） m L,（ t =3. 228,P = 0. 042） ],so the difference was significant（ P = 0. 042）,but it was significantly less than that in the Routine group[（ 120 ± 55. 9） m L vs（ 583. 0 ± 135. 4） m L,（ t = 5. 446,P = 0. 032） ]. The postoperative rate of residual stones in the Choledochoscopic lithotomy group was significantly lower than that in the ERCP ＋ ESWL group and in the Routine group（ P = 0. 008） The postoperative rate of pain relief was significantly higher than that in the Routine group（ 90% vs 50%） and in the ERCP ＋ ESWL group（ 90% vs 50%）. Conclusion For the surgical treatment of pancreatolithiasis,it can significantly decrease the postoperative rate of residual stones and introperative blood loss,and increase the postoperative rate of pain relief in the midsection when Choledochoscopy and extracorporeal shock wave lithotripsy are used jointly.