胆石病手术治疗方式的选择  

Surgical strategy in selecting the treatment of cholelithiasis

作　　者：帅建[1] 戴丽萍[1] 余小舫[1] 鲍世韵[1] 郑锦锋[1] 张桌[1] 

机构地区：[1]暨南大学医学院第二临床医学院深圳市人民医院肝胆外科,广东深圳518020

出　　处：《外科理论与实践》2006年第3期224-226,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨胆石病治疗方法的决策。方法:我院近2年收治各种胆石病626例。分别采用开腹手术、腹腔镜胆囊切除术(LC)、内镜下逆行胰胆管造影(ERCP)、内镜下括约肌切开(EST)或网篮套石、术中或术后胆道镜,或联合治疗方式。结果:本组直接行开腹胆囊切除术17例(3%);行LC 562例(包括ERCP等治疗后行LC者78例),554例成功施行,术后恢复良好,无并发症,另8例(1.38%)中转开腹胆囊切除术,术中并发症2例(0.45%);胆囊结石并轻度胆管扩张或黄疸22例中,15例先行ERCP,5例发现有胆总管下端细小结石并成功取出后再作LC,7例直接行LC,术后仅有1例须再作ERCP,取出胆总管下端小结石;胆囊结石并胆总管或肝总管结石68例,作EST或网篮套石,63例(92.5%)成功取尽结石并行LC。肝内胆管结石48例全部施行开腹手术,术前作ERCP、鼻胆管引流术13例,术中均联合用胆道镜取石,并有7例行左肝外叶切除,5例行右肝段或局部病灶切除,1例行胆肠吻合术,2例行肝胆管外引流术,1例肝胆管成形术,术后经T管或U形管窦道胆道镜取石、狭窄肝胆管扩张术21例。全部治愈,无结石残留。本组共有96例经十二指肠镜操作,11例有轻型胰腺炎(淀粉酶增高,轻微上腹疼痛),治疗2～3 d后恢复,不影响后续治疗,其他20例并发症主要为肝内胆管结石术后,经保守治疗后治愈,全组无死亡病例。结论:腹腔镜、胆道镜和十二指肠镜为胆石病的外科治疗提供了多样化选择,这些内镜或是单独应用,或是与手术相结合,或是相互联合的治疗模式,极大地改善了各种胆石病的治疗效果。Objective To determine the feasibility and effectiveness of various surgical approaches in treating cholelithiasis. Methods A group of 626 cholelithiasis patients undergoing different operations including open cholecystectomy, laparoscopic cholecystectomy （LC）,endoscopic retrograde cholangiopancreato graphy （ERCP）, endoscopic sphincterotomy （EST）, fiber choledochoscopy and their combinations were retrospectively analyzed. Results The number of patients undergoing open cholecystectomy and LC was 17 and 562, respectively. In the LC group, 78 cases received pre-operative ERCP, 8 cases were converted to open cholecystectomy during the LC procedure, and 2 cases were complicated with bleeding or duodenal injury. Fifteen of 22 patients with mild choledochectasia or mild jaundice were subjected to ERCP, followed by LC and in the other 7 patients undergoing LC without prior ERCP, one of them was subjected to postoperative ERCP. ERCP or EST was performed in 68 cases of extra-hepatic bile duct stone. Sixty-three of them underwent LC after successful bile duct stone extirpation. All 48 cases of intra-hepatic bile duct stone were submitted to laparotomy, 13 of them were subjected to pre-operative ERCP or ENBD. Segmental hepatectomy, cholangio-enteral anastomosis, external drainage or cholangioplasty were further performed under different circumstances in the 48 cases, and their overall success rate was 100% without residual stone. A total of 96 cases underwent duodenoscopy, and post-ERCP pancreatitis occurred in 11 cases. Conclusions Combined endoscopic-laparoscopic technique plays an important role in the surgical treatment of cholelithiasis. Its rational application may improve the results of treatment in cholelithiasis.

关 键 词：胆结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 括约肌切开术 内窥镜 

分 类 号：R657.42[医药卫生—外科学]