腹腔镜下经胆囊管逆向乳头插管法治疗胆囊结石合并细径胆总管结石的临床疗效  

Clinical effect of laparoscopic reverse papillary intubation through cystic duct to treat cholecystolithiasis and thining choledocholithiasis

作　　者：孙科[1] 肖宏[1] 陈安平[1] 田刚[1] 尹思能[1] 李连博[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,610017

出　　处：《中华消化外科杂志》2016年第4期363-367,共5页Chinese Journal of Digestive Surgery

基　　金：成都市卫生局重大科技攻关项目（20130024）

摘　　要：目的探讨腹腔镜下经胆囊管逆向乳头插管法和腹腔镜联合十二指肠镜治疗胆囊结石合并细径胆总管结石的临床疗效。方法采用回顾性队列研究方法。收集2012年5月至2015年8月成都市第二人民医院收治的192例胆囊结石合并细径胆总管结石患者的临床资料。96例患者采用腹腔镜下经胆囊管逆向乳头插管法治疗胆囊结石合并细径胆总管结石设为研究组，96例患者采用腹腔镜联合十二指肠镜法治疗胆囊结石合并细径胆总管结石设为对照组。两组患者均首先按照常规方法完成LC。研究组患者采用经胆囊管置入4Fr输尿导管，在腹腔镜直视下置入胆总管并通过十二指肠乳头，针状刀沿输尿管走向正前方切开十二指肠乳头，用取石网或取石球囊取尽结石。对照组患者采用弓形刀带斑马导丝的常规方式进行插管，弓形刀沿11点方向切开十二指肠乳头，使用取石网或取石球囊取尽结石。术中通过鼻胆管造影检查观察是否有胆总管结石残留，比较两组患者以下情况：（1）手术情况：手术插管、手术时间。（2）术后情况：术后ALT、术后AST、术后TBil、术后血淀粉酶、术后脂肪酶、并发症和拔管时间。（3）随访情况。术后采用门诊或电话随访，通过经鼻胆管逆行胆道造影检查，或行MRCP、超声检查了解患者结石复发情况。随访时间截至2015年11月。正态分布的计量资料以-x±s表示，组间比较用t检验；计数资料比较用，检验。结果（1）手术情况：两组患者均在腹腔镜下成功切除胆囊。研究组患者均成功通过胆囊管置入输尿管导管，其中8例置管较困难。对照组中5例患者因憩室旁乳头或其他原因无法完成插管，EST失败，改为经胆囊管置输尿管导管通过乳头引导十二指肠乳头切开。研究组和对照组患者手术时间分别为（89±17）min和（105±26）min，两组比较，差异有统�Objective To investigate the clinical effect of laparoscopic reverse papillary intubation through cystic duct and laparoscope combined with duodenoscope in the treatment of eholecystolithiasis and thining choledocholithiasis. Methods The retrospective cohort study was adopted. The clinical data of 192 patients with cholecystolithiasis and thining choledocholithiasis who were admitted to Chengdu Second People＇s Hospital between May 2012 to August 2015 were collected. The 96 patients who underwent laparoscopic reverse papillary intubation through cystic duct were allocated into the case group, and the other 96 who received surgery by laparoscope combined with duodenoscope were allocated into the control group. All the patients underwent laparoscopic cholecystectomy （LC） according to routine approaches. The 96 patients in the case group received the placement of 4 Fr ureter catheter via cystic duct and placement of common bile duct inserted through the duodenal papilla under laparoscope, and then the duodenal papilla was resected using needle knife along the ureter catheter and stones were removed by basket lithotriptor and ball lithotriptor. The 96 patients in the control group received the intubation using the bow knife with zebra guidewire, and stones were removed by basket lithotriptor and ball lithotriptor. During the operations, it was observed whether there were residual stones by nasobiliary radiograph. The comparison was made between the 2 groups concerning （ 1 ） surgical situation： intubation and operation time. （2） Postoperative alanine transaminase （ALT）, postoperative aspartate transaminase （AST）, postoperative total bilirubin （TBil）, postoperative blood amylase, postoperative lipase, complications and extubation time. （3） Situation of follow-up： follow-up was done by outpatient examination or telephone interview up to November 2015. The stones recurrence was detected by retrograde cholangiography through nasal bile duct, magnetic resonance cholangiopancreatography （M

关 键 词：胆石症 胆总管结石 腹腔镜检查 内窥镜检查 鼻胆管引流 

分 类 号：R657.42[医药卫生—外科学]