A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincter...A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.展开更多
目的:分析并比较腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流术治疗继发性肝外胆管结石的临床效果.方法:选取2012-01/2014-06承德医学院附属...目的:分析并比较腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流术治疗继发性肝外胆管结石的临床效果.方法:选取2012-01/2014-06承德医学院附属医院收治的90例继发性肝外胆管结石患者,根据不同的手术方式将其分为观察组以及对照组,每组45例,其中观察组给予LTCBDE治疗,对照组给予腹腔镜胆道探查"T"管引流术(laparoscopic common bile duct exploration,LCBDE),比较两组患者的手术时间、术中出血量、住院费用、以及术后并发症情况.结果:观察组的手术时间明显长于对照组,但其术中出血量、术后住院时间、住院费用、术后补液量以及术后带管时间明显少于对照组,观察组中术后近期并发症的发生率为2.22%(1/45),远期并发症发生率为0,对照组分别为13.33%(6/45)及11.11%(5/45),组间比较有统计学差异(?2=7.349、5.281,P<0.05).结论:只要掌握好手术适应证,LTCBDE具有微创、并发症少、术后恢复快的特点,值得临床推广应用.展开更多
文摘A retained bile duct stone after operation for cholelithiasis still occurs and causes symptoms such as biliary colic and obstructive jaundice.An endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy(EST),followed by stone extraction,are usually an effective treatment for this condition.However,these procedures are associated with severe complications including pancreatitis,bleeding,and duodenal perforation.Nitrates such as glyceryl trinitrate(GTN) and isosorbide dinitrate(ISDN) are known to relax the sphincter of Oddi.In 6 cases in which a retained stone was detected following cholecystectomy,topical nitrate drip infusion via cystic duct tube(C-tube) was carried out.Retained stones of 2-3 mm diameter and no dilated common bile duct in 3 patients were removed by drip infusion of 50 mg GTN or 10 mg ISDN,which was the regular dose of intravenous injection.Three other cases failed,and EST in 2 cases and endoscopic biliary balloon dilatation in 1 case were performed.One patient developed an adverse event of nausea.Severe complications were not observed.We consider the topical nitrate drip infusion via C-tube to be old but safe,easy,and inexpensive procedure for retained bile duct stone following cholecystectomy,inasmuch as removal rate was about 50% in our cases.
文摘目的:分析并比较腹腔镜下经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)与腔镜胆道探查"T"管引流术治疗继发性肝外胆管结石的临床效果.方法:选取2012-01/2014-06承德医学院附属医院收治的90例继发性肝外胆管结石患者,根据不同的手术方式将其分为观察组以及对照组,每组45例,其中观察组给予LTCBDE治疗,对照组给予腹腔镜胆道探查"T"管引流术(laparoscopic common bile duct exploration,LCBDE),比较两组患者的手术时间、术中出血量、住院费用、以及术后并发症情况.结果:观察组的手术时间明显长于对照组,但其术中出血量、术后住院时间、住院费用、术后补液量以及术后带管时间明显少于对照组,观察组中术后近期并发症的发生率为2.22%(1/45),远期并发症发生率为0,对照组分别为13.33%(6/45)及11.11%(5/45),组间比较有统计学差异(?2=7.349、5.281,P<0.05).结论:只要掌握好手术适应证,LTCBDE具有微创、并发症少、术后恢复快的特点,值得临床推广应用.
