三镜联合胆囊切除及胆道探查术治疗急性梗阻性化脓性胆管炎的临床效果  

Clinical effects of duodenoscopy, laparoscopy, and choledochoscopy combined with cholecystectomy and common bile duct exploration in treatment of acute obstructive suppurative cholangitis

作　　者：牛海刚[1] 高瑞忠[1] 朱福义 张国锋 

机构地区：[1]山西医科大学汾阳学院外科教研室,山西省汾阳市032200 [2]山西省汾阳医院普外科,山西省汾阳市032200

出　　处：《世界华人消化杂志》2014年第36期5688-5692,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨三镜(十二指肠镜、腹腔镜、胆道镜)联合胆囊切除及胆道探查术治疗急性梗阻性化脓性胆管炎(acute obstructive suppurative cholangitis,AOSC)的临床效果.方法:按照随机数字表法将山西省汾阳医院普外科收治的96例AOSC患者随机分为观察组和对照组.患者入院后均行常规检查和治疗,在此基础上观察组给予内镜下逆行胰胆管造影(endoscopic retrograde cholangiopanc reatography,ERCP)+鼻胆管引流(endoscopic naso-biliary drainage,ENBD)+乳头括约肌切开术(endoscopic sphincteropapillotomy,EST)+腹腔镜下胆囊切除胆道探查术(laparoscopic cholecystectomy bile duct exploration,LCBDE)联合治疗,对照组给予开腹胆囊切除及胆道探查术治疗.观察两组患者术前、术后直接胆红素、谷丙转氨酶、白细胞计数、血清白蛋白、胆碱酯酶水平变化情况;记录患者手术时间、术中出血量、肛门排气时间以及住院时间;观察患者术后并发症、结石残留、切口感染情况.结果:观察组患者术后1 wk直接胆红素、谷丙转氨酶、白细胞计数、血清白蛋白、胆碱酯酶水平变化程度显著优于对照组(6.63μmol/L±1.82μmol/L vs 11.34μmol/L±2.8μmol/L;23.38μmol/L±10.47μmol/L vs 40.25μmol/L±16.30μmol/L;6.53×109/L±2.13×109/L vs9.65×109/L±3.10×109/L;40.34 g/L±6.53 g/L vs 33.64 g/L±5.21 g/L;7.10 U/L±1.82 U/L v s 4.93 U/L±1.63 U/L),差异有统计学意义(P<0.05);两组患者手术时间比较(128.34 min±12.58 min vs 118.58 min±11.67 min),差异无统计学意义(P>0.05);观察组患者术中出血量、肛门排气时间及住院时间与对照组比较有显著性差异(54.20 m L±10.10 m L vs 252.50m L±75.16 m L;23.16 h±3.64 h vs 70.25 h±10.53 h;5.50 d±1.13 d vs 15.50 d±4.38 d),差异有统计学意义(P<0.05);随访9-12 mo,观察组患者术后并发症、切口感染和结石残留发生率显著低于对照组(6.25%vs 31.25%),差异有统计学意义(P<0.05).结论:ERCP+ENBD+EST+LCBDE联合治疗AOSC能�AIM： To observe the clinical effects of duodenoscopy, laparoscopy, and choledochoscopy combined with cholecystectomy and common bile duct exploration in the treatment of acute obstructive suppurative cholangitis （AOSC）. METHODS： Ninety-six patients with AOSC treated at our hospital were randomly divided into either an observation group or a control group. Both groups underwent routine examination and treatment. The observation group additionally underwent endoscopic retrograde cholangiopancreatography （ERCP） ＋ endoscopic naso-biliary drainage （ENBD） ＋ endoscopic sphincteropapillotomy （EST） ＋ laparoscopic cholecystectomy bile duct exploration （LCBDE） combination therapy, and the control group received open cholecystectomy and common bile duct exploration. Direct bilirubin, alanine aminotransferase, white blood cell count, serum albumin, and cholinesterase were compared between the two groups. Operative time, amount of intraoperative bleeding, time to anal exhaust, hospital stay, postoperative complications, residual stones, and incision infection were also compared. RESULTS： Direct bilirubin, alanine transaminase, white blood cell count, albumin, and cholinesterase levels at postoperative week 1 were significantly better in the observation group than in the control group （6.63 μmol/L ± 1.82 μmol/L vs 11.34 μmol/L ± 2.8 μmol/L; 23.38 μmol/L ± 10.47 μmol/L vs 40.25 μmol/L ± 16.30 μmol/L; 6.53 × 10^9/L ± 2.13 × 10^9/L vs 9.65 × 10^9/L ± 3.10 × 10^9/L; 40.34 g/L ± 6.53 g/L vs 33.64 g/L ± 5.21 g/L; 7.10 U/L ± 1.82 U/L vs 4.93 U/L ± 1.63 U/L; P 〈 0.05）. Operative time did not differ significantly between the two groups （128.34 min ± 12.58 min vs 118.58 min ± 11.67 min, P 〉 0.05）. Blood loss, time to anal exhaust and hospital stay were significantly better in the observation group （54.20 mL ± 10.10 mL vs 252.50 mL ± 75.16 mL; 23.16 h ± 3.64 h vs 70.25 h ± 10.53 h; 5.50 d ± 1.13 d vs 15.50 d ± 4.38 d; P 〈 0.05）. During 9 to 12 mo of follow-u

关 键 词：急性梗阻性化脓性胆管炎 十二指肠镜 腹腔镜 胆道镜 胆囊切除及胆道探查术 

分 类 号：R657.4[医药卫生—外科学]