摘要
目的:探讨腹腔镜、十二指肠镜、气囊鼻胆管探查术(laparoscopic duodenoscopic balloon nasobiliary exploration,LDBNE)同期治疗胆囊结石合并细径胆总管结石的应用体会.方法:回顾性分析2010-04/2015-07成都市第二人民医院运用LDBNE的手术方式,对59例胆囊结石合并细径胆总管(胆总管内径约2-8mm)结石的患者进行治疗的临床材料.结果:LDBNE治疗59例,成功切除胆囊59例;乳头切开取净结石42例(成功率71.2%),联合气囊鼻胆管下取净结石11例(成功率18.6%),中转为经胆囊管汇合部切口和胆总管前壁切口胆管镜下取净结石5例(中转率8.5%);术后胆管残留结石1例(1.7%),排石治愈.术后胆漏1例(1.7%),经术中放置的鼻胆管引流和腹腔引流自愈.术后轻症胰腺炎3例(5.1%),经保守治愈.术后总并发症发生率为8.5%(5/59).术后其他并发症均经非手术综合疗法治愈.无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡.结论:只要病例选择合适,LDBNE治疗胆囊结石合并细径胆总管结石是可行、有效和安全的.
AIM:To present our experience with the management of cholecystolithiasis with stones in the small-diameter common bile duct by using duodenoscopic balloon nasobiliary exploration(LDBNE) during the course of therapeutic laparoscopy.METHODS:The clinical data for 59 cholecystolithiasis patients with stones in the small-diameter common bile duct(0.2-0.8 cm) who underwent laparoscopic duodenoscopic papillotomy,balloon nasobiliary exploration and cholelithotomy(LDBNE) from April 2010 to July 2015 at the Second People's Hospital of Chengdu City were analyzed retrospectively.RESULTS:LDBNE was performed in 59 cases,and the gallbladder was successfully removed in all the 59 cases.The common bile duct stones were removed by duodenoscopic papillotomy in 42(71.2%) cases and by balloon nasobiliary in 11(18.6%) cases.Five(8.5%)cases were converted to laparoscopic common bile duct exploration.Residual stone after duodenoscopic papillotomy was noted in 1(1.7%) case.Bile leakage developed in 1(1.7%)case and was cured by patent drainage and nasobiliary drainage postoperatively.Three(5.1%) cases developed mild pancreatitis and were conservatively cured.The rate of overall postoperative complications was 8.5%(5/ 59).No perforation of the intestine or bile duct,bleeding,severe pancreatitis or death occurred.CONCLUSION:Application of duodenoscopic balloon nasobiliary exploration to therapeutic laparoscopy for treatment of cholecystolithiasis with stones in the small-diameter common bile duct is safe and effective.
出处
《世界华人消化杂志》
CAS
2015年第31期5050-5055,共6页
World Chinese Journal of Digestology