目的 采用腹腔镜、内镜联合技术处理胆囊结石合并肝外胆管结石,对同期及分期治疗的结果进行比较。方法 患者60例,其中同期处理36例,分期处理24例。术前诊断依据B超、ERCP或MRCP检查,术中诊断依据术中胆道镜检查和胆道造影,全部病例均诊断为慢性胆囊炎合并胆总管结石。同期手术者直接行腹腔镜胆囊切除术,胆道镜和(或)造影检查后行腹腔镜经胆囊管或胆总管胆道镜取石,闭合胆管开口或放置T管。分期手术者先行或者后行ERCP+经内镜乳头切开术/经内镜乳头气囊扩张术取石,再行常规的腹腔镜胆囊切除术。结果 60例患者腹腔镜胆囊切除术均成功,同期手术者手术时间40~90 min,平均68 min,术后发生1例漏胆; 分期手术者2次手术时间共60~120 min,平均80 min。同期手术者手术时间明显短于分期手术者(P<0.01),而术后并发症发生情况二者间差异则无统计学意义(Pgt;0.05)。同期手术者住院费用较少(P<0.01),同时在胆总管一期缝合或胆囊管一期结扎的情况下,住院时间相对较短(P<0.01)。结论 腹腔镜胆囊切除术+腹腔镜下胆道镜胆总管探查术或经胆囊管探查术同期治疗胆囊结石合并肝外胆管结石安全可靠,值得进一步研究、推广。
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
目的比较腹腔镜下胆总管探查一期缝合与T管引流治疗肝外胆管结石的效果,总结腹腔镜下胆总管探查一期缝合的临床经验。 方法回顾性分析2010年1月至2012年12月期间于中国人民解放军总医院施行腹腔镜下胆总管探查取石的121例肝外胆管结石患者的临床资料,比较一期缝合组(n=63)与T管引流组(n=58)的手术时间、术中出血量、术后住院时间、胆瘘发生率、胆总管狭窄发生率及结石复发率。 结果2组患者均顺利完成腹腔镜手术。术后一期缝合组发生胆瘘3例,T管引流组发生1例。2组患者的术中出血量和胆瘘发生率比较差异均无统计学意义(P>0.05),但T管引流组的手术时间和术后住院时间均较长(P=0.000)。术后所有患者获访4~36个月,平均12个月。随访期间均无复发、胆总管狭窄及死亡发生。 结论腹腔镜下胆总管探查一期缝合治疗肝外胆管结石安全而有效,并且避免了术后T管的护理,有望成为处理肝外胆管结石的主流术式。
目的比较腹腔镜胆囊切除联合胆总管探查术(LC+LCBDE)与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术(EST+LC)治疗胆囊结石合并肝外胆管结石的临床疗效。 方法回顾性分析45例行LC+LCBDE及60例行EST+LC患者的临床资料,观察2组在单次结石清除率、中转手术率、手术并发症、住院时间等指标方面的效果。 结果2组患者的基线资料相近,无手术死亡病例;2组术后并发症发生情况的差异无统计学意义(P>0.05);LC+LCBDE组单次治疗成功率高于EST+LC组,而住院时间及中转手术率则短于或低于EST+LC组(P<0.05)。 结论LC+LCBDE是治疗胆囊结石合并肝外胆管结石患者安全有效的方法。