气囊鼻胆管在治疗细径胆总管结石中的临床应用59例

Application of duodenoscopic balloon nasobiliary exploration to therapeutic laparoscopy for treatment of cholecystolithiasis with stones in the small-diameter common bile duct: Analysis of 59 cases

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.