十二指肠镜与腹腔镜治疗肝外胆管结石手术时机的研究  

The best operative opportunity between duodenoscopy and laparoscopic cholecystectomy in the management of calculus of extrahepatic bile duct

作　　者：黄韬[1] 郑成竹[1] 

机构地区：[1]第二军医大学长海医院,上海200433

出　　处：《腹腔镜外科杂志》2008年第1期62-65,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨十二指肠镜与腹腔镜治疗肝外胆管结石的最佳手术时间间隔。方法:先行十二指肠镜逆行胰胆管造影+内镜下十二指肠乳头切开术治疗胆总管结石,研究组在72h内行腹腔镜胆囊切除术;对照组在72h后行腹腔镜胆囊切除术。对比治疗后两组胆囊标本壶腹区平均中性粒细胞数,腹腔镜胆囊切除术操作时间及并发症发生率等指标。结果:研究组胆囊标本壶腹区平均中性粒细胞数少于对照组,为(3.4±1.3)vs.(7.8±1.1),(t=-14.247,P=0.000),平均手术操作时间短于对照组,为(24.6±2.8)h vs.(37.8±3.1)h,(t=-17.464,P=0.000),并发症发生率与对照组相比无显著性差异(3.2%vs.3.3%,χ2=0.000,P=1.000)。结论:逆行胰胆管造影+十二指肠乳头切开取石术与腹腔镜胆囊切除术的最佳间隔时间是<72h。Objective：To explore the best operation opportunity between endoscopic retrograde cholangiopancreatography （ERCP）, endoscopic sphincterotomy （EST） and laparoscopic cholecystectomy （LC） in the management of calculus of extrahepatic bile duct. Methods：First common bile duct calculi （CBDC） cured by ERCP ＋ EST. In research group,LC was followed ERCP ＋ EST within 72 hours and LC was followed ERCP ＋ EST after 72 hours in control group. Contrast to the average number of neutrophil gallbladder ampulla triangle,the average time of LC operation and the postoperative complication in two groups. Results：The average number of neutrophil was fewer （3.4 ± 1.3 ） vs. （7.8 ±1.1 ）, （ t = -14.247,P = 0.000） and the average time of LC was shorter in research group （24.6± 2.8） vs. （37.8 ±3.1 ） , （t = -17. 464 ,P =0.000） ,the postoperative complication was no difference in two groups（3.2% vs. 3.3% , X^2 =0. 000,P = 1. 000）. Conclusions：The best operation opportunity between ERCP ＋ EST and LC in the management of calculus of extrahepatic bile duct is within 72 hours.

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

分 类 号：R657.4[医药卫生—外科学]