胆道镜引导下胰管切开取石加T管引流术治疗胰管结石

Choledochoscope-guided Pancreatolithotomy and T Tube Drainage for Pancreatic Duct Stones

目的探讨在胰管切开胆道镜引导下进行胰管探查取石与T管引流的可行性及优缺点。方法回顾性分析2006年至2016年在承德医学院附属保定市第二医院及河南科技大学第一附属医院普外科18例胰管结石患者的临床资料。其中,保定市第二医院2例,河南科技大学第一附属医院16例。结果 8例接受胰管切开胆道镜取石并T管引流术的患者,胰管扩张均有改善,其中6例腹痛完全缓解,2例大部缓解,无胰漏等并发症发生。5例行胰管空肠吻合手术,3例行胰体尾+脾脏切除,2例行保留脾脏的胰体尾切除。结论胰管切开胆道镜取石并T管引流术,相比内镜取石,有更好的彻底性和简便性;相比开放的胰肠吻合或胰腺切除,有更少的并发症;能最大限度地保留功能性的胰腺组织,对胰—胆管汇合处通畅的患者而言,具有不可比拟的优势。

ObjectiveTo investigate the feasibility,advantages and disadvantages of choledochoscope guided pancreatolithotomy combined with T tube drainage for pancreatic duct stones.Methods18cases of pancreatic duct stones,during2006to2016,from the Second hospital of Baoding Affiliated to Chengde Medical College and the First Affiliated Hospital of Henan University of Science and Technology,were retrospective analyzed.ResultsIn the18cases,8cases of pancreatic duct stones were dealed with choledochoscope guided pancreatolithotomy combined with T tube drainage.In this group,the pancreatic duct dilatation was improved postoperatively in all8cases.The abdominal pain was completely relieved in6cases,and partially relieved in the other2cases.No pancreatic leakage occurred.The other5cases underwent pancreatic jejunostomy.3cases underwent distal pancreatectomy with spleen.2cases underwent spleen preserving distal pancreatectomy.ConclusionCompared with endoscopic lithotomy or open pancreaticojejunostomy,pancreatolithotomy combined with T tube drainage was simple,and its postoperative complications were few.It did not change the normal physiological structure.It could maximally retain the functional pancreatic tissues,and has an incomparable advantage for patients with normal pancreaticobiliary ductal union.