腹腔镜下逐级导管乳头扩张术治疗胆总管结石的临床应用研究

The clinical application of laparoscopic gradual catheter papillary dilatation in the treatment of choledocholithiasis

目的:分析腹腔镜下逐级导管乳头扩张术治疗胆总管结石的临床疗效及应用价值。方法:回顾分析2015年4月至2019年4月收治的58例胆总管结石患者的临床资料,其中30例在腹腔镜下逐级导管乳头扩张后行胆总管一期缝合术(观察组),28例直接行胆总管一期缝合术(对照组)。对比分析两组治疗效果。结果:观察组术后3 d AST、ALT及直接胆红素下降更快,术后住院时间短,与对照组相比差异有统计学意义(P<0.05);两组手术时间、术中出血量差异无统计学意义(P>0.05)。术后观察组出现急性胰腺炎症状1例,对照组发生胆漏2例,均经保守治疗后痊愈。术后随访6个月,对照组胆总管结石复发1例。结论:腹腔镜下逐级导管乳头扩张术可使术后胆总管下端胆汁引流更通畅,加速术后肝功能损害及黄疸的恢复,具有一定的推广应用价值。

Objective:To analyze the therapeutic effect and clinical application value of laparoscopic gradual catheter papillary dilatation in the treatment of choledocholithiasis.Methods:Clinical data of 58 patients with choledocholithiasis from Apr.2015 to Apr.2019 were analyzed retrospectively.Among them,30 patients underwent laparoscopic primary suture of common bile duct after gradual catheter papillary dilatation(observation group),28 patients directly underwent laparoscopic primary suture of common bile duct(control group).The clinical effects of the two groups were compared and analyzed.Results:The AST,ALT and direct bilirubin in the observation group decreased faster than those in the control group at 3 d after operation,the postoperative hospital stay in the observation group was shorter than that in the control group(P<0.05).There was no significant difference in operation time and intraoperative blood loss(P>0.05).There was 1 case of acute pancreatitis in the observation group and 2 cases of bile leakage in the control group,all of which were cured after conservative treatment.After follow-up of 6 months,1 case of choledocholithiasis recurred in the control group.Conclusions:Laparoscopic gradual catheter papillary dilation can make the bile drainage at the lower end of the common bile duct more unobstructed.It can accelerate the recovery of liver function and jaundice,so it has certain clinical application and promotion value.