MRCP正常的合并轻型胆源性胰腺炎病史的胆囊结石患者术中胆道探查的结果分析

Analysis of intraoperative bile duct exploration in patients with gallstone,normal MRCP and history of mild biliary pancreatitis

目的 探讨腹腔镜下经胆囊管胆道探查术对磁共振胰胆管造影(MRCP)正常的既往有轻型胆源性胰腺炎病史的胆囊结石患者胆管结石诊断结果的分析,探讨术中胆道探查的必要性和安全性。方法 回顾性总结2009年1月至2019年12月期间就诊于首都医科大学附属北京友谊医院的既往明确诊断为胰腺炎、术前MRCP检查结果正常(胆管结石直径小于8 mm并且未见明确胆管结石)的胆囊结石患者临床资料,共纳入患者96例,男性55例,女性41例;年龄范围18~80岁,中位年龄为57岁。腹腔镜胆囊切除手术术中行经胆囊管胆道镜探查术明确胆管结石情况。主要观察指标为胆管结石阳性率,次要观察指标包括住院期间并发症发生率,腹腔镜下经胆囊管胆道探查术的成功率、结石清除率和胆管结石残留率。结果 87例患者成功完成了经胆囊管胆道探查术,探查成功率为90.6%;55例(56.3%)患者发现胆管内结石,全部经胆囊管途径取石成功,取石成功率100.0%。住院期间1例患者出现术后并发症(轻度胰腺炎),整体的并发症的发生率为1.0%。结论 对既往有轻度胆源性胰腺炎病史的胆囊结石患者,当术前MRCP检查正常时,建议腹腔镜胆囊切除手术时同时行腹腔镜下经胆囊管胆道探查术;腹腔镜下经胆囊管胆道探查术具有较低的并发症风险,较高的探查成功率和取石成功率,能够同期完成诊断和治疗的目标。

Objective To investigate the diagnosis of bile duct stones in gallstone patients with normal magnetic resonance cholangiopancreatography( MRCP) and previous history of biliary pancreatitis,and to explore the necessity and safety of intraoperative bile duct exploration.Methods From January 2009 to December 2019,the clinical data of 96 patients with gallstone who had previously been diagnosed with pancreatitis and had normal preoperative MRCP results( the diameter of bile duct stones less than 8 mm and no bile duct stones) who visited Beijing Friendship Hospital,Capital Medical University were retrospectively summarized,55 males and 41 females,aged from 18 to 80 years,the median age was 57 years.During laparoscopic cholecystectomy,choledochoscopy through the cystic duct was performed to determine the condition of bile duct stones.The main outcome measure was the positive rate of bile duct stones.Secondary outcome measures included the incidence of complications during hospitalization,the success rate of laparoscopic transcystic duct exploration,the rate of stone clearance,and the rate of residual bile duct stones.Results Eighty-seven patients successfully completed the exploration of biliary tract through cystic duct,and the success rate of exploration was 90.6%.Fifty-five patients( 56.3%) found stones in the bile duct.All stones were removed successfully through the cystic duct.The success rate of stone removal was 100.0%.One patient had postoperative complications( mild pancreatitis) during hospitalization.The overall incidence of complications was 1.0%.Conclusion For gallstone patients with a history of mild biliary pancreatitis,when the preoperative MRCP is normal,it is suggested that laparoscopic transcystic bile duct exploration should be performed at the same time of laparoscopic cholecystectomy.Laparoscopic transcystic bile duct exploration has lower risk of complications,higher success rate of exploration and stone removal,and can complete the goals of diagnosis and treatment at the same time.