目的对老年急性胰腺炎合并胆囊结石伴胆总管结石早期行腹腔镜胆囊切除联合腹腔镜胆总管探查术(Laparoscopic Cholecystectomy plus Laparoscopic Transcystic Common Bile Duct Exploration,LC+LCBDE)的病例进行回顾性分析,并评估其安...目的对老年急性胰腺炎合并胆囊结石伴胆总管结石早期行腹腔镜胆囊切除联合腹腔镜胆总管探查术(Laparoscopic Cholecystectomy plus Laparoscopic Transcystic Common Bile Duct Exploration,LC+LCBDE)的病例进行回顾性分析,并评估其安全性。方法选取2012年10月~2016年10月我科收治的急性水肿型胰腺炎合并胆囊结石伴胆总管结石患者443例,分为四组,其中年龄大于60岁,行LC+LTCBDE患者为老年LTCBDE组(n=101),行LC+LTDBDE患者为老年LTDBDE组(n=98);年龄小于60岁,行LC+LTCBDE患者为中青年LTCBDE组(n=132),行LC+LTDBDE患者为中青年LTCBDE组(n=112)。对各组手术中情况、手术并发症、术后恢复情况等方面进行比较。结果与老年LTDBDE组(3.14±0.33h)和中青年LTDBDE组(3.11±0.34h)比较,老年LTCBDE组(2.24±0.23h)和中青年LTCBDE组(2.12±0.40h)手术时间明显缩短(P<0.05);术中出血量(△Hb)及中转开腹率差异均无统计学意义(P>0.05)。与中青年LTCBDE组(1/132)、中青年LTDBDE组(2/112)比较,老年LTCBDE组(8/155)、老年LTCBDE组(6/98)肺部感染高(P<0.05),差异有统计学意义(P<0.05)。其余并发症胆漏、胆总管损伤、切口感染、肠梗阻四组间两两比较,均无显著性差异(P>0.05)。与中青年LTCBDE组(3.24±0.11 d)与中青年LTDBDE组(3.54±0.20d)比较,老年LTCBDE组(6.72±0.44d)、老年LTDBDE组(7.45±0.20d)住院天数延长,差异有统计学意义(P<O.05)。胰腺炎复发率、残余结石发生率差异均无统计学意义(P>0.05)。结论老年急性胰腺炎合并胆囊结石伴胆总管结石患者在胰腺炎控制后,即可选择早期施行LC+LTCBDE,并不影响手术安全性。经胆囊管路径探查胆总管优于其他术式,值得推广。展开更多
目的对胆总管结石患者行腹腔镜胆总管探查术(Laparoscopic Common Bile Duct Exploration,LCBDE)治疗的病例进行回顾性分析,比较LCBDE术中应用连续缝合法与间断缝合法缝合胆总管的手术效果与安全性。方法选取2012年1月~2018年1月我科收...目的对胆总管结石患者行腹腔镜胆总管探查术(Laparoscopic Common Bile Duct Exploration,LCBDE)治疗的病例进行回顾性分析,比较LCBDE术中应用连续缝合法与间断缝合法缝合胆总管的手术效果与安全性。方法选取2012年1月~2018年1月我科收治的胆总管结石患者56例,分为2组,其中行LCBDE术应用连续缝合法缝合胆总管为连续缝合组(n=32),行LCBDE术应用间断缝合法缝合胆总管为间断缝合组(n=24);两组手术时间、术中出血量、术后胆漏、胆总管狭窄、住院天数等方面进行比较。结果与间断缝合组比较,连续缝合法使手术时间缩短,差异有统计学意义(P<0.05)。术后胆漏、黄疸、胆总管狭窄等手术并发症无显著性差异(P>0.05)。术中出血量、术后住院天数、引流管拔除天数等无显著性差异(P>0.05)。结论在LCBDE术中应用连续缝合法或间断缝合法缝合胆总管,安全性无显著性差异,连续缝合法可以缩短手术时间,提高手术效率,值得推广。展开更多
AIM: To analyze retrospectively the records of 294 conse-cutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectivel...AIM: To analyze retrospectively the records of 294 conse-cutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model. METHODS: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model. Prospective validation of the model was made.RESULTS: Discriminant forward stepwise analysis disclosed that high values (≥ 2×normal) of SGOT, ALP, conjugated bilirubin and CBD diameter on ultrasound ≥ 10 mm were all prognostic factors of CBD lithiasis in univariate and multivariate analysis, P＜0.01. History was not included in the model. Prospective validation of the model was performed by multivariate analysis using Visual General Stepwise Regression. Positive predictive value,when considering all these predictors, was 93.3%, while the negative predictive value was 88.8%. Sensitivity of the model was 96.5% and specificity 80%.CONCLUSION: The above model can be objectively applied to predict the presence of CBD stones.展开更多
目的探究多层螺旋CT对胆总管结石的影像表现及诊断价值。方法由本院放射科两名副主任医师采用双盲法进行阅片,回顾性分析我院53例经手术或逆行胰胆管造影(ERCP)证实胆总管结石的CT影像资料。结果经过手术后病理确诊37例,ERCP确诊10例,...目的探究多层螺旋CT对胆总管结石的影像表现及诊断价值。方法由本院放射科两名副主任医师采用双盲法进行阅片,回顾性分析我院53例经手术或逆行胰胆管造影(ERCP)证实胆总管结石的CT影像资料。结果经过手术后病理确诊37例,ERCP确诊10例,正确率达88.67%(47/53);CT平扫横截面和增强后横截面的敏感性为81.3%和88.9%;CT平扫横截面和增强之后横截面特异性为78.1%和89.4%;47例胆总管结石患者中高密度结石23例、点片状高密度阴影泥沙样结石14例、软组织样密度结石3例、低密度结石5例、混合密度结石2例;胆总管直径分布范围依次为6~11 mm 15例、>11 mm 29例、>20 mm 3例。结论多层螺旋CT增强扫描能够较精准的呈现胆总管结石的密度、形状、位置,对结石密度进行较精准的分型,可为临床诊断治疗胆总管结石提供依据,具有一定临床应用价值。展开更多
文摘目的对老年急性胰腺炎合并胆囊结石伴胆总管结石早期行腹腔镜胆囊切除联合腹腔镜胆总管探查术(Laparoscopic Cholecystectomy plus Laparoscopic Transcystic Common Bile Duct Exploration,LC+LCBDE)的病例进行回顾性分析,并评估其安全性。方法选取2012年10月~2016年10月我科收治的急性水肿型胰腺炎合并胆囊结石伴胆总管结石患者443例,分为四组,其中年龄大于60岁,行LC+LTCBDE患者为老年LTCBDE组(n=101),行LC+LTDBDE患者为老年LTDBDE组(n=98);年龄小于60岁,行LC+LTCBDE患者为中青年LTCBDE组(n=132),行LC+LTDBDE患者为中青年LTCBDE组(n=112)。对各组手术中情况、手术并发症、术后恢复情况等方面进行比较。结果与老年LTDBDE组(3.14±0.33h)和中青年LTDBDE组(3.11±0.34h)比较,老年LTCBDE组(2.24±0.23h)和中青年LTCBDE组(2.12±0.40h)手术时间明显缩短(P<0.05);术中出血量(△Hb)及中转开腹率差异均无统计学意义(P>0.05)。与中青年LTCBDE组(1/132)、中青年LTDBDE组(2/112)比较,老年LTCBDE组(8/155)、老年LTCBDE组(6/98)肺部感染高(P<0.05),差异有统计学意义(P<0.05)。其余并发症胆漏、胆总管损伤、切口感染、肠梗阻四组间两两比较,均无显著性差异(P>0.05)。与中青年LTCBDE组(3.24±0.11 d)与中青年LTDBDE组(3.54±0.20d)比较,老年LTCBDE组(6.72±0.44d)、老年LTDBDE组(7.45±0.20d)住院天数延长,差异有统计学意义(P<O.05)。胰腺炎复发率、残余结石发生率差异均无统计学意义(P>0.05)。结论老年急性胰腺炎合并胆囊结石伴胆总管结石患者在胰腺炎控制后,即可选择早期施行LC+LTCBDE,并不影响手术安全性。经胆囊管路径探查胆总管优于其他术式,值得推广。
文摘目的对胆总管结石患者行腹腔镜胆总管探查术(Laparoscopic Common Bile Duct Exploration,LCBDE)治疗的病例进行回顾性分析,比较LCBDE术中应用连续缝合法与间断缝合法缝合胆总管的手术效果与安全性。方法选取2012年1月~2018年1月我科收治的胆总管结石患者56例,分为2组,其中行LCBDE术应用连续缝合法缝合胆总管为连续缝合组(n=32),行LCBDE术应用间断缝合法缝合胆总管为间断缝合组(n=24);两组手术时间、术中出血量、术后胆漏、胆总管狭窄、住院天数等方面进行比较。结果与间断缝合组比较,连续缝合法使手术时间缩短,差异有统计学意义(P<0.05)。术后胆漏、黄疸、胆总管狭窄等手术并发症无显著性差异(P>0.05)。术中出血量、术后住院天数、引流管拔除天数等无显著性差异(P>0.05)。结论在LCBDE术中应用连续缝合法或间断缝合法缝合胆总管,安全性无显著性差异,连续缝合法可以缩短手术时间,提高手术效率,值得推广。
文摘AIM: To analyze retrospectively the records of 294 conse-cutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model. METHODS: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model. Prospective validation of the model was made.RESULTS: Discriminant forward stepwise analysis disclosed that high values (≥ 2×normal) of SGOT, ALP, conjugated bilirubin and CBD diameter on ultrasound ≥ 10 mm were all prognostic factors of CBD lithiasis in univariate and multivariate analysis, P＜0.01. History was not included in the model. Prospective validation of the model was performed by multivariate analysis using Visual General Stepwise Regression. Positive predictive value,when considering all these predictors, was 93.3%, while the negative predictive value was 88.8%. Sensitivity of the model was 96.5% and specificity 80%.CONCLUSION: The above model can be objectively applied to predict the presence of CBD stones.
文摘目的探究多层螺旋CT对胆总管结石的影像表现及诊断价值。方法由本院放射科两名副主任医师采用双盲法进行阅片,回顾性分析我院53例经手术或逆行胰胆管造影(ERCP)证实胆总管结石的CT影像资料。结果经过手术后病理确诊37例,ERCP确诊10例,正确率达88.67%(47/53);CT平扫横截面和增强后横截面的敏感性为81.3%和88.9%;CT平扫横截面和增强之后横截面特异性为78.1%和89.4%;47例胆总管结石患者中高密度结石23例、点片状高密度阴影泥沙样结石14例、软组织样密度结石3例、低密度结石5例、混合密度结石2例;胆总管直径分布范围依次为6~11 mm 15例、>11 mm 29例、>20 mm 3例。结论多层螺旋CT增强扫描能够较精准的呈现胆总管结石的密度、形状、位置,对结石密度进行较精准的分型,可为临床诊断治疗胆总管结石提供依据,具有一定临床应用价值。
