三镜在高龄胆总管结石并发急性重症胆管炎治疗中的应用  

Application of Three-Endoscopy in Treatment for Elderly Patients with Common Bile Duct Stones Associated with Severe Acute Cholangitis

作　　者：徐知非[1] 郑华芳[1] 岳雁鸿[1] 刘锐[1] 

机构地区：[1]眉山市中医医院普外科,四川眉山620010

出　　处：《中国普外基础与临床杂志》2013年第5期543-546,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结腹腔镜、十二指肠镜及胆道镜在高龄胆总管结石并发急性重症胆管炎治疗中的效果。方法收集2008年5月至2012年12月期间来我院治疗的高龄胆总管结石并发急性重症胆管炎患者86例,分析患者的手术方式及治疗效果。结果①行腹腔镜下胆囊切除术(LC)+胆总管切开联合胆道镜下取石术患者31例,手术成功31例,发生胆管穿孔1例(3.22%);总有效率为96.77%(30/31);住院时间(9.05±2.11)d,住院费用(1.47±0.34)万元。②行十二指肠镜下乳头切开取石术+LC手术患者43例,手术成功42例,1例转其他术式手术成功,发生残余结石2例(4.65%);总有效率为97.67%(42/43);住院时间(8.64±1.20)d,住院费用(2.36±0.62)万元。③行十二指肠镜下鼻胆管引流术+LC+胆总管切开联合胆道镜下取石术患者12例,手术成功12例,无转其他术式情况,无并发症发生;总有效率为91.67%(11/12);住院时间(11.06±2.33)d,住院费用(2.79±0.41)万元。所有患者未发生肠穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论三镜在高龄胆总管结石并发急性重症胆管炎中的治疗效果良好,根据患者不同情况选择合适术式,手术成功率高,并发症发生率和死亡率低。Objective To summarize the therapeutic efficacy of laparoscope,duodenoscope,and choledochoscope in treatment for elderly patients with common bile duct stones associated with acute severe cholangitis.Methods Eighty-six patients with common bile duct stones associated with severe acute cholangitis from May 2008 to December 2012 in this hospital were chosen.The operation methods and their therapeutic efficacy were analyzed.Results ① Thirty-one patients were performed by laparoscopic cholecystectomy（LC） plus common bile duct discission combined with choledochoscope for removing the stones,which were completely successful.One case of bile duct perforation happened.The total effective rate was 96.77%？（30/31）.The hospital stay was（9.05±2.11） d,the hospital costs was（1.47±0.34） ten thousand yuan.② Forty-three patients were performed by LC combined with duodenoscopic papillotomy,42 patients were successful, one patients was turned to the other operation,the retained calculus was found in two patients.The total effective rate was 97.67%？（42/43）.The hospital stay was（8.64±1.20） d,the hospital costs was（2.36±0.62） ten thousand yuan.③ Twelve patients were performed by endoscopic nasobiliary drainage and LC plus common bile duct discission combined with choledochoscope for removing the stones,which were completely successful.The total effective rate was 91.67%（11/12）.The hospital stay was（11.06±2.33） d,the hospital costs was（2.79±0.41） ten thousand yuan.No severe complications such as intestinal perforation,hemorrhea,and severe acute pancreatitis and no death happened.Conclusions Three-endoscopy in treatment for elderly patients with common bile duct stones associated with severe acute cholangitis has a good therapeutic efficacy,a suitable operation is chosen according to the different conditions of the patients,the success rate is high,the complication rate and the mortality rate are low.

关 键 词：胆总管结石 急性重症胆管炎 腹腔镜 胆道镜 十二指肠镜 

分 类 号：R657.4[医药卫生—外科学]