ERCP联合内镜下十二指肠乳头括约肌切开术治疗胆囊结石合并胆总管结石的临床分析  

Clinical analysis of endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy in treatment of cholecystolithiasis and choledocholith

作　　者：黄建峰[1] 翟东升[1] 黄强[1] 

机构地区：[1]湖北民族学院附属民大医院肝胆胰外科

出　　处：《实用临床医药杂志》2015年第23期72-74,共3页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11523179)

摘　　要：目的探讨内镜下逆行胰胆管造影术(ERCP)联合内镜下十二指肠乳头括约肌切开术(EST)治疗胆囊结石合并胆总管结石的临床疗效及安全性。方法选取胆囊结石合并胆总管结石患者137例,均行ERCP+EST治疗。观察患者手术情况、术后残余结石情况和并发症发生情况;记录手术时间、术中出血量、术后禁食时间、排便时间和住院时间。结果 133例患者顺利完成ERCP+EST手术,手术成功率97.08%(133/137)。其中120例术后1周内行三孔法LC,30例ERCP术后出现血淀粉酶升高,5例并发急性胰腺炎,2例Oddi括约肌出血。患者平均手术时间、术中出血量、术后禁食时间、排便时间和住院时间分别为(50.78±16.45)min、(17.85±6.20)m L、(2.21±0.84)d、(1.82±0.80)d及(3.87±1.60)d。一期结石清除率为97.74%(130/133),二期为100%(3/3)。门诊随访6个月,未发现结石复发和胆道狭窄。结论 ERCP+EST+LC治疗胆囊结石合并胆总管结石具有创伤小、效果好、恢复快、并发症少、残余结石少等优点,是最佳微创治疗方案,值得临床广泛应用。Objective To investigate the clinical effects and safety of endoscopic retrograde cholangiopancreatography（ ERCP） combined with endoscopic sphincterotomy（ EST） in treatment of cholecystolithiasis and choledocholith. Methods A total of 137 patients with cholecystolithiasis and choledocholith underwent ERCP ＋ EST ＋ laparoscopic cholecystectomy（ LC）. The operation condition,residual stones after operation and complication were observed,and surgical duration,intraoperative blood loss,postoperative fasting time,defecating time and length of stay were recorded. Results A total of 133 patients（ 97. 08%） completed the ERCP ＋ EST successfully,in which 120 cases underwent three- port- looping LC,30 cases with increased blood amylase,5 cases with acute pancreatitis and 2 cases with sphincter of Oddi bleeding after surgery. The mean surgical duration,intraoperative blood loss postoperative fasting time,defecating time and length of stay were（ 50. 78 ± 16. 45） min,（ 17. 85 ± 6. 20） m L,（ 2. 21 ± 0. 84） d,（ 1. 82 ± 0. 80） d and（ 3. 87 ± 1. 60） d,respectively. First and second time stone clearance rate were 97. 74%（ 130 /133） and 100%（ 3 /3）,respectively. There was no calculus recurrence or biliary Stricture in 6 month follow- up. Conclusion ERCP ＋ EST ＋LC,with minimal trauma,rapid recovery,less complication and residual stones,is an optimal mini-invasive operation for cholecystolithiasis and choledocholith.

关 键 词：经内镜逆行性胰胆管造影术 乳头括约肌切开术 胆总管结石 腹腔镜胆囊切除术 

分 类 号：R364.2[医药卫生—病理学]